|
STENT VISION 3.5 x 28mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974789
|
|
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 MULTI-LINK 4.0 x 12mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107484
|
|
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 MULTI-LINK 4.0 x 12mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107484
|
|
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 MULTI-LINK 4.0 x 18mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107483
|
|
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 MULTI-LINK 4.0 x 18mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107483
|
|
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 VISI-PRO 7mm X 27mm X135 #PXB35-07-27-135
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2974786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
STENT VISI-PRO 7mm X 27mm X135 #PXB35-07-27-135
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2974786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,939.04 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,047.81
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
STENT VISIPRO 7 X 12 #PXB35-07-12-80
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.35 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,877.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,679.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,138.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,932.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,750.74
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,707.18
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: NAPHCARE Commercial |
$6,165.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,679.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6,165.74
|
| Rate for Payer: The Alliance Commercial |
$5,138.12
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT VISIPRO 7 X 12 #PXB35-07-12-80
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,035.36 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,165.74
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT VISIPRO 7 X 17 #PXB35-07-17-80
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,035.36 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,165.74
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT VISIPRO 7 X 17 #PXB35-07-17-80
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.35 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,877.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,679.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,138.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,932.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,750.74
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,707.18
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: NAPHCARE Commercial |
$6,165.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,679.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6,165.74
|
| Rate for Payer: The Alliance Commercial |
$5,138.12
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT VISPRO 7mm X 27mm #PXB35-07-27-080
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,035.36 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,165.74
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT VISPRO 7mm X 27mm #PXB35-07-27-080
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.35 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,877.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,679.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,138.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,932.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,750.74
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,707.18
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: NAPHCARE Commercial |
$6,165.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,679.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6,165.74
|
| Rate for Payer: The Alliance Commercial |
$5,138.12
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT WALLFLEX 10 X 60MM COVERED M00570370
|
Facility
|
OP
|
$14,941.00
|
|
| Hospital Charge Code |
3455499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,350.82 |
| Max. Negotiated Rate |
$14,295.55 |
| Rate for Payer: Aetna Commercial |
$13,984.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,363.23
|
| Rate for Payer: Aetna Managed Medicare |
$4,350.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,100.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,769.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,458.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,235.48
|
| Rate for Payer: Cash Price |
$4,482.30
|
| Rate for Payer: Cigna Commercial |
$14,295.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,695.66
|
| Rate for Payer: Health EOS Commercial |
$13,829.39
|
| Rate for Payer: HFN Commercial |
$14,295.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,653.98
|
| Rate for Payer: Multiplan Commercial |
$12,430.91
|
| Rate for Payer: NAPHCARE Commercial |
$9,323.18
|
| Rate for Payer: Preferred Network Access Commercial |
$14,295.55
|
| Rate for Payer: Quartz Beloit One Network |
$7,613.93
|
| Rate for Payer: Quartz Commercial |
$10,100.12
|
| Rate for Payer: Quartz Medicare Advantage |
$9,323.18
|
| Rate for Payer: The Alliance Commercial |
$7,769.32
|
| Rate for Payer: WEA Trust Commercial |
$8,546.25
|
| Rate for Payer: WPS Commercial |
$11,509.05
|
|
|
STENT WALLFLEX 10 X 60MM COVERED M00570370
|
Facility
|
IP
|
$14,941.00
|
|
| Hospital Charge Code |
3455499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,613.93 |
| Max. Negotiated Rate |
$14,295.55 |
| Rate for Payer: Aetna Commercial |
$13,984.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,363.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,235.48
|
| Rate for Payer: Cash Price |
$4,482.30
|
| Rate for Payer: Cigna Commercial |
$14,295.55
|
| Rate for Payer: Health EOS Commercial |
$13,829.39
|
| Rate for Payer: HFN Commercial |
$14,295.55
|
| Rate for Payer: Multiplan Commercial |
$12,430.91
|
| Rate for Payer: Preferred Network Access Commercial |
$14,295.55
|
| Rate for Payer: Quartz Beloit One Network |
$7,613.93
|
| Rate for Payer: Quartz Commercial |
$9,323.18
|
| Rate for Payer: WEA Trust Commercial |
$8,546.25
|
| Rate for Payer: WPS Commercial |
$11,509.05
|
|
|
STENT WALLFLEX 10 X 60MM UNCOVERED 7064
|
Facility
|
OP
|
$10,067.00
|
|
| Hospital Charge Code |
3072562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT WALLFLEX 10 X 60MM UNCOVERED 7064
|
Facility
|
IP
|
$10,067.00
|
|
| Hospital Charge Code |
3072562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT WALLFLEX 10 X 80MM COVERED M00570380
|
Facility
|
OP
|
$14,941.00
|
|
| Hospital Charge Code |
3455498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,350.82 |
| Max. Negotiated Rate |
$14,295.55 |
| Rate for Payer: Aetna Commercial |
$13,984.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,363.23
|
| Rate for Payer: Aetna Managed Medicare |
$4,350.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,100.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,769.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,458.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,235.48
|
| Rate for Payer: Cash Price |
$4,482.30
|
| Rate for Payer: Cigna Commercial |
$14,295.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,695.66
|
| Rate for Payer: Health EOS Commercial |
$13,829.39
|
| Rate for Payer: HFN Commercial |
$14,295.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,653.98
|
| Rate for Payer: Multiplan Commercial |
$12,430.91
|
| Rate for Payer: NAPHCARE Commercial |
$9,323.18
|
| Rate for Payer: Preferred Network Access Commercial |
$14,295.55
|
| Rate for Payer: Quartz Beloit One Network |
$7,613.93
|
| Rate for Payer: Quartz Commercial |
$10,100.12
|
| Rate for Payer: Quartz Medicare Advantage |
$9,323.18
|
| Rate for Payer: The Alliance Commercial |
$7,769.32
|
| Rate for Payer: WEA Trust Commercial |
$8,546.25
|
| Rate for Payer: WPS Commercial |
$11,509.05
|
|
|
STENT WALLFLEX 10 X 80MM COVERED M00570380
|
Facility
|
IP
|
$14,941.00
|
|
| Hospital Charge Code |
3455498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,613.93 |
| Max. Negotiated Rate |
$14,295.55 |
| Rate for Payer: Aetna Commercial |
$13,984.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,363.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,235.48
|
| Rate for Payer: Cash Price |
$4,482.30
|
| Rate for Payer: Cigna Commercial |
$14,295.55
|
| Rate for Payer: Health EOS Commercial |
$13,829.39
|
| Rate for Payer: HFN Commercial |
$14,295.55
|
| Rate for Payer: Multiplan Commercial |
$12,430.91
|
| Rate for Payer: Preferred Network Access Commercial |
$14,295.55
|
| Rate for Payer: Quartz Beloit One Network |
$7,613.93
|
| Rate for Payer: Quartz Commercial |
$9,323.18
|
| Rate for Payer: WEA Trust Commercial |
$8,546.25
|
| Rate for Payer: WPS Commercial |
$11,509.05
|
|
|
STENT WALLFLEX 10 X 80MM UNCOVERED 7065
|
Facility
|
OP
|
$9,030.00
|
|
| Hospital Charge Code |
3072563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.54 |
| Max. Negotiated Rate |
$8,639.90 |
| Rate for Payer: Aetna Commercial |
$8,452.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,076.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,629.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,104.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,695.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,507.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,977.34
|
| Rate for Payer: Cash Price |
$2,709.00
|
| Rate for Payer: Cigna Commercial |
$8,639.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,255.46
|
| Rate for Payer: Health EOS Commercial |
$8,358.17
|
| Rate for Payer: HFN Commercial |
$8,639.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,043.40
|
| Rate for Payer: Multiplan Commercial |
$7,512.96
|
| Rate for Payer: NAPHCARE Commercial |
$5,634.72
|
| Rate for Payer: Preferred Network Access Commercial |
$8,639.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,601.69
|
| Rate for Payer: Quartz Commercial |
$6,104.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,634.72
|
| Rate for Payer: The Alliance Commercial |
$4,695.60
|
| Rate for Payer: WEA Trust Commercial |
$5,165.16
|
| Rate for Payer: WPS Commercial |
$6,955.81
|
|
|
STENT WALLFLEX 10 X 80MM UNCOVERED 7065
|
Facility
|
IP
|
$9,030.00
|
|
| Hospital Charge Code |
3072563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,601.69 |
| Max. Negotiated Rate |
$8,639.90 |
| Rate for Payer: Aetna Commercial |
$8,452.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,076.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,977.34
|
| Rate for Payer: Cash Price |
$2,709.00
|
| Rate for Payer: Cigna Commercial |
$8,639.90
|
| Rate for Payer: Health EOS Commercial |
$8,358.17
|
| Rate for Payer: HFN Commercial |
$8,639.90
|
| Rate for Payer: Multiplan Commercial |
$7,512.96
|
| Rate for Payer: Preferred Network Access Commercial |
$8,639.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,601.69
|
| Rate for Payer: Quartz Commercial |
$5,634.72
|
| Rate for Payer: WEA Trust Commercial |
$5,165.16
|
| Rate for Payer: WPS Commercial |
$6,955.81
|
|
|
STENT WALLFLEX 18 X 23CM FULLY COVERED M00516700
|
Facility
|
IP
|
$12,447.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
5432732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,342.99 |
| Max. Negotiated Rate |
$11,909.29 |
| Rate for Payer: Aetna Commercial |
$11,650.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,132.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,860.79
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,909.29
|
| Rate for Payer: Health EOS Commercial |
$11,520.94
|
| Rate for Payer: HFN Commercial |
$11,909.29
|
| Rate for Payer: Multiplan Commercial |
$10,355.90
|
| Rate for Payer: Preferred Network Access Commercial |
$11,909.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,342.99
|
| Rate for Payer: Quartz Commercial |
$7,766.93
|
| Rate for Payer: WEA Trust Commercial |
$7,119.68
|
| Rate for Payer: WPS Commercial |
$9,587.92
|
|
|
STENT WALLFLEX 18 X 23CM FULLY COVERED M00516700
|
Facility
|
OP
|
$12,447.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
5432732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.57 |
| Max. Negotiated Rate |
$11,909.29 |
| Rate for Payer: Aetna Commercial |
$11,650.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,132.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,624.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,414.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,472.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,213.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,860.79
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,909.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,244.15
|
| Rate for Payer: Health EOS Commercial |
$11,520.94
|
| Rate for Payer: HFN Commercial |
$11,909.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,708.66
|
| Rate for Payer: Multiplan Commercial |
$10,355.90
|
| Rate for Payer: NAPHCARE Commercial |
$7,766.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,909.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,342.99
|
| Rate for Payer: Quartz Commercial |
$8,414.17
|
| Rate for Payer: Quartz Medicare Advantage |
$7,766.93
|
| Rate for Payer: The Alliance Commercial |
$6,472.44
|
| Rate for Payer: WEA Trust Commercial |
$7,119.68
|
| Rate for Payer: WPS Commercial |
$9,587.92
|
|
|
STENT WALLFLEX 18 X 23CM PARTIAL COVERED 1690
|
Facility
|
OP
|
$13,118.00
|
|
| Hospital Charge Code |
3072560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,819.96 |
| Max. Negotiated Rate |
$12,551.30 |
| Rate for Payer: Aetna Commercial |
$12,278.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,732.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,819.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,867.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,821.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,548.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,230.64
|
| Rate for Payer: Cash Price |
$3,935.40
|
| Rate for Payer: Cigna Commercial |
$12,551.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,634.68
|
| Rate for Payer: Health EOS Commercial |
$12,142.02
|
| Rate for Payer: HFN Commercial |
$12,551.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,232.04
|
| Rate for Payer: Multiplan Commercial |
$10,914.18
|
| Rate for Payer: NAPHCARE Commercial |
$8,185.63
|
| Rate for Payer: Preferred Network Access Commercial |
$12,551.30
|
| Rate for Payer: Quartz Beloit One Network |
$6,684.93
|
| Rate for Payer: Quartz Commercial |
$8,867.77
|
| Rate for Payer: Quartz Medicare Advantage |
$8,185.63
|
| Rate for Payer: The Alliance Commercial |
$6,821.36
|
| Rate for Payer: WEA Trust Commercial |
$7,503.50
|
| Rate for Payer: WPS Commercial |
$10,104.80
|
|
|
STENT WALLFLEX 18 X 23CM PARTIAL COVERED 1690
|
Facility
|
IP
|
$13,118.00
|
|
| Hospital Charge Code |
3072560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,684.93 |
| Max. Negotiated Rate |
$12,551.30 |
| Rate for Payer: Aetna Commercial |
$12,278.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,732.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,230.64
|
| Rate for Payer: Cash Price |
$3,935.40
|
| Rate for Payer: Cigna Commercial |
$12,551.30
|
| Rate for Payer: Health EOS Commercial |
$12,142.02
|
| Rate for Payer: HFN Commercial |
$12,551.30
|
| Rate for Payer: Multiplan Commercial |
$10,914.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,551.30
|
| Rate for Payer: Quartz Beloit One Network |
$6,684.93
|
| Rate for Payer: Quartz Commercial |
$8,185.63
|
| Rate for Payer: WEA Trust Commercial |
$7,503.50
|
| Rate for Payer: WPS Commercial |
$10,104.80
|
|
