|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 9CM M00534220
|
Facility
|
OP
|
$2,045.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2972823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.50 |
| Max. Negotiated Rate |
$1,956.66 |
| Rate for Payer: Aetna Commercial |
$1,914.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.05
|
| Rate for Payer: Aetna Managed Medicare |
$595.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,382.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,063.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,020.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.20
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,956.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,190.19
|
| Rate for Payer: Health EOS Commercial |
$1,892.85
|
| Rate for Payer: HFN Commercial |
$1,956.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,595.10
|
| Rate for Payer: Multiplan Commercial |
$1,701.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,276.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,956.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.13
|
| Rate for Payer: Quartz Commercial |
$1,382.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,276.08
|
| Rate for Payer: The Alliance Commercial |
$1,063.40
|
| Rate for Payer: WEA Trust Commercial |
$1,169.74
|
| Rate for Payer: WPS Commercial |
$1,575.26
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 5CM M00534260
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.80 |
| Max. Negotiated Rate |
$2,033.20 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Aetna Managed Medicare |
$618.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,436.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,060.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,171.30
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,236.75
|
| Rate for Payer: Health EOS Commercial |
$1,966.90
|
| Rate for Payer: HFN Commercial |
$2,033.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,657.50
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,326.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,033.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.90
|
| Rate for Payer: Quartz Commercial |
$1,436.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,326.00
|
| Rate for Payer: The Alliance Commercial |
$1,105.00
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.89
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 5CM M00534260
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.90 |
| Max. Negotiated Rate |
$2,033.20 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,171.30
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: Health EOS Commercial |
$1,966.90
|
| Rate for Payer: HFN Commercial |
$2,033.20
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,033.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.90
|
| Rate for Payer: Quartz Commercial |
$1,326.00
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.89
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 7CM M00534270
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.90 |
| Max. Negotiated Rate |
$2,033.20 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,171.30
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: Health EOS Commercial |
$1,966.90
|
| Rate for Payer: HFN Commercial |
$2,033.20
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,033.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.90
|
| Rate for Payer: Quartz Commercial |
$1,326.00
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.89
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 7CM M00534270
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.80 |
| Max. Negotiated Rate |
$2,033.20 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Aetna Managed Medicare |
$618.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,436.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,060.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,171.30
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,236.75
|
| Rate for Payer: Health EOS Commercial |
$1,966.90
|
| Rate for Payer: HFN Commercial |
$2,033.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,657.50
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,326.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,033.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.90
|
| Rate for Payer: Quartz Commercial |
$1,436.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,326.00
|
| Rate for Payer: The Alliance Commercial |
$1,105.00
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.89
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 9CM M00534280
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.80 |
| Max. Negotiated Rate |
$1,957.61 |
| Rate for Payer: Aetna Commercial |
$1,915.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.94
|
| Rate for Payer: Aetna Managed Medicare |
$595.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,383.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,063.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,021.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.76
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,957.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,190.77
|
| Rate for Payer: Health EOS Commercial |
$1,893.78
|
| Rate for Payer: HFN Commercial |
$1,957.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,595.88
|
| Rate for Payer: Multiplan Commercial |
$1,702.27
|
| Rate for Payer: NAPHCARE Commercial |
$1,276.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.64
|
| Rate for Payer: Quartz Commercial |
$1,383.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,276.70
|
| Rate for Payer: The Alliance Commercial |
$1,063.92
|
| Rate for Payer: WEA Trust Commercial |
$1,170.31
|
| Rate for Payer: WPS Commercial |
$1,576.03
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 9CM M00534280
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.64 |
| Max. Negotiated Rate |
$1,957.61 |
| Rate for Payer: Aetna Commercial |
$1,915.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.76
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,957.61
|
| Rate for Payer: Health EOS Commercial |
$1,893.78
|
| Rate for Payer: HFN Commercial |
$1,957.61
|
| Rate for Payer: Multiplan Commercial |
$1,702.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.64
|
| Rate for Payer: Quartz Commercial |
$1,276.70
|
| Rate for Payer: WEA Trust Commercial |
$1,170.31
|
| Rate for Payer: WPS Commercial |
$1,576.03
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5F X 12CM 3429
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3949318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.64 |
| Max. Negotiated Rate |
$1,957.61 |
| Rate for Payer: Aetna Commercial |
$1,915.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.76
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,957.61
|
| Rate for Payer: Health EOS Commercial |
$1,893.78
|
| Rate for Payer: HFN Commercial |
$1,957.61
|
| Rate for Payer: Multiplan Commercial |
$1,702.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.64
|
| Rate for Payer: Quartz Commercial |
$1,276.70
|
| Rate for Payer: WEA Trust Commercial |
$1,170.31
|
| Rate for Payer: WPS Commercial |
$1,576.03
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5F X 12CM 3429
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3949318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.80 |
| Max. Negotiated Rate |
$1,957.61 |
| Rate for Payer: Aetna Commercial |
$1,915.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.94
|
| Rate for Payer: Aetna Managed Medicare |
$595.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,383.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,063.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,021.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.76
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,957.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,190.77
|
| Rate for Payer: Health EOS Commercial |
$1,893.78
|
| Rate for Payer: HFN Commercial |
$1,957.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,595.88
|
| Rate for Payer: Multiplan Commercial |
$1,702.27
|
| Rate for Payer: NAPHCARE Commercial |
$1,276.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.64
|
| Rate for Payer: Quartz Commercial |
$1,383.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,276.70
|
| Rate for Payer: The Alliance Commercial |
$1,063.92
|
| Rate for Payer: WEA Trust Commercial |
$1,170.31
|
| Rate for Payer: WPS Commercial |
$1,576.03
|
|
|
STENT EVERFLEX 7mm X 20mm X120 #PRB35-07-20-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.34 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,164.50
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
STENT EVERFLEX 7mm X 20mm X120 #PRB35-07-20-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.76 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,876.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,678.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,137.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,931.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,749.58
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,705.62
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: NAPHCARE Commercial |
$6,164.50
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,678.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,164.50
|
| Rate for Payer: The Alliance Commercial |
$5,137.08
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
STENT EVERFLEX 7mm X 40mm X120 #PRB35-07-40-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.34 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,164.50
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
STENT EVERFLEX 7mm X 40mm X120 #PRB35-07-40-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.76 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,876.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,678.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,137.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,931.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,749.58
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,705.62
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: NAPHCARE Commercial |
$6,164.50
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,678.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,164.50
|
| Rate for Payer: The Alliance Commercial |
$5,137.08
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
STENT EVERFLEX 7 X 150mm #PRB35-07-150-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.76 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,876.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,678.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,137.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,931.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,749.58
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,705.62
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: NAPHCARE Commercial |
$6,164.50
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,678.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,164.50
|
| Rate for Payer: The Alliance Commercial |
$5,137.08
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
STENT EVERFLEX 7 X 150mm #PRB35-07-150-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.34 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,164.50
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
Stent Fem/Pop incl PTA
|
Facility
|
IP
|
$9,389.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
3052447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,784.63 |
| Max. Negotiated Rate |
$8,983.40 |
| Rate for Payer: Aetna Commercial |
$8,788.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,397.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,175.22
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cigna Commercial |
$8,983.40
|
| Rate for Payer: Health EOS Commercial |
$8,690.46
|
| Rate for Payer: HFN Commercial |
$8,983.40
|
| Rate for Payer: Multiplan Commercial |
$7,811.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,983.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,784.63
|
| Rate for Payer: Quartz Commercial |
$5,858.74
|
| Rate for Payer: WEA Trust Commercial |
$5,370.51
|
| Rate for Payer: WPS Commercial |
$7,232.35
|
|
|
Stent Fem/Pop incl PTA
|
Facility
|
OP
|
$9,389.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
3052447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,734.08 |
| Max. Negotiated Rate |
$19,394.96 |
| Rate for Payer: Aetna Commercial |
$8,788.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,397.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,734.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,175.22
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cigna Commercial |
$8,983.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$8,690.46
|
| Rate for Payer: HFN Commercial |
$8,983.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,323.42
|
| Rate for Payer: Multiplan Commercial |
$7,811.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,858.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,983.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,784.63
|
| Rate for Payer: Quartz Commercial |
$6,346.96
|
| Rate for Payer: Quartz Medicare Advantage |
$5,858.74
|
| Rate for Payer: The Alliance Commercial |
$4,882.28
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$5,370.51
|
| Rate for Payer: WPS Commercial |
$7,232.35
|
|
|
STENT FLEX 6 x 60 120
|
Facility
|
IP
|
$6,711.00
|
|
| Hospital Charge Code |
2974857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,419.93 |
| Max. Negotiated Rate |
$6,421.08 |
| Rate for Payer: Aetna Commercial |
$6,281.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,002.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,699.10
|
| Rate for Payer: Cash Price |
$2,013.30
|
| Rate for Payer: Cigna Commercial |
$6,421.08
|
| Rate for Payer: Health EOS Commercial |
$6,211.70
|
| Rate for Payer: HFN Commercial |
$6,421.08
|
| Rate for Payer: Multiplan Commercial |
$5,583.55
|
| Rate for Payer: Preferred Network Access Commercial |
$6,421.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,419.93
|
| Rate for Payer: Quartz Commercial |
$4,187.66
|
| Rate for Payer: WEA Trust Commercial |
$3,838.69
|
| Rate for Payer: WPS Commercial |
$5,169.48
|
|
|
STENT FLEX 6 x 60 120
|
Facility
|
OP
|
$6,711.00
|
|
| Hospital Charge Code |
2974857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,954.24 |
| Max. Negotiated Rate |
$6,421.08 |
| Rate for Payer: Aetna Commercial |
$6,281.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,002.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,536.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,489.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,350.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,699.10
|
| Rate for Payer: Cash Price |
$2,013.30
|
| Rate for Payer: Cigna Commercial |
$6,421.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,905.80
|
| Rate for Payer: Health EOS Commercial |
$6,211.70
|
| Rate for Payer: HFN Commercial |
$6,421.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,234.58
|
| Rate for Payer: Multiplan Commercial |
$5,583.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,187.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,421.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,419.93
|
| Rate for Payer: Quartz Commercial |
$4,536.64
|
| Rate for Payer: Quartz Medicare Advantage |
$4,187.66
|
| Rate for Payer: The Alliance Commercial |
$3,489.72
|
| Rate for Payer: WEA Trust Commercial |
$3,838.69
|
| Rate for Payer: WPS Commercial |
$5,169.48
|
|
|
STENT GENESIS 4 x 14mm PG1540BAX
|
Facility
|
IP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,118.59 |
| Max. Negotiated Rate |
$7,732.86 |
| Rate for Payer: Aetna Commercial |
$7,564.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,228.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,454.80
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna Commercial |
$7,732.86
|
| Rate for Payer: Health EOS Commercial |
$7,480.70
|
| Rate for Payer: HFN Commercial |
$7,732.86
|
| Rate for Payer: Multiplan Commercial |
$6,724.22
|
| Rate for Payer: Preferred Network Access Commercial |
$7,732.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,118.59
|
| Rate for Payer: Quartz Commercial |
$5,043.17
|
| Rate for Payer: WEA Trust Commercial |
$4,622.90
|
| Rate for Payer: WPS Commercial |
$6,225.56
|
|
|
STENT GENESIS 4 x 14mm PG1540BAX
|
Facility
|
OP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.48 |
| Max. Negotiated Rate |
$7,732.86 |
| Rate for Payer: Aetna Commercial |
$7,564.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,228.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,353.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,463.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,202.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,034.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,454.80
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna Commercial |
$7,732.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,703.72
|
| Rate for Payer: Health EOS Commercial |
$7,480.70
|
| Rate for Payer: HFN Commercial |
$7,732.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,303.96
|
| Rate for Payer: Multiplan Commercial |
$6,724.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,043.17
|
| Rate for Payer: Preferred Network Access Commercial |
$7,732.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,118.59
|
| Rate for Payer: Quartz Commercial |
$5,463.43
|
| Rate for Payer: Quartz Medicare Advantage |
$5,043.17
|
| Rate for Payer: The Alliance Commercial |
$4,202.64
|
| Rate for Payer: WEA Trust Commercial |
$4,622.90
|
| Rate for Payer: WPS Commercial |
$6,225.56
|
|
|
STENT GENESIS 4 X 17mm PG1840BAX
|
Facility
|
IP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,118.59 |
| Max. Negotiated Rate |
$7,732.86 |
| Rate for Payer: Aetna Commercial |
$7,564.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,228.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,454.80
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna Commercial |
$7,732.86
|
| Rate for Payer: Health EOS Commercial |
$7,480.70
|
| Rate for Payer: HFN Commercial |
$7,732.86
|
| Rate for Payer: Multiplan Commercial |
$6,724.22
|
| Rate for Payer: Preferred Network Access Commercial |
$7,732.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,118.59
|
| Rate for Payer: Quartz Commercial |
$5,043.17
|
| Rate for Payer: WEA Trust Commercial |
$4,622.90
|
| Rate for Payer: WPS Commercial |
$6,225.56
|
|
|
STENT GENESIS 4 X 17mm PG1840BAX
|
Facility
|
OP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.48 |
| Max. Negotiated Rate |
$7,732.86 |
| Rate for Payer: Aetna Commercial |
$7,564.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,228.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,353.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,463.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,202.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,034.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,454.80
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna Commercial |
$7,732.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,703.72
|
| Rate for Payer: Health EOS Commercial |
$7,480.70
|
| Rate for Payer: HFN Commercial |
$7,732.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,303.96
|
| Rate for Payer: Multiplan Commercial |
$6,724.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,043.17
|
| Rate for Payer: Preferred Network Access Commercial |
$7,732.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,118.59
|
| Rate for Payer: Quartz Commercial |
$5,463.43
|
| Rate for Payer: Quartz Medicare Advantage |
$5,043.17
|
| Rate for Payer: The Alliance Commercial |
$4,202.64
|
| Rate for Payer: WEA Trust Commercial |
$4,622.90
|
| Rate for Payer: WPS Commercial |
$6,225.56
|
|
|
STENT GENESIS 5mm X 14mm PG1550BSS
|
Facility
|
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,493.14 |
| Max. Negotiated Rate |
$8,436.11 |
| Rate for Payer: Aetna Commercial |
$8,252.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,885.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,859.93
|
| Rate for Payer: Cash Price |
$2,645.10
|
| Rate for Payer: Cigna Commercial |
$8,436.11
|
| Rate for Payer: Health EOS Commercial |
$8,161.02
|
| Rate for Payer: HFN Commercial |
$8,436.11
|
| Rate for Payer: Multiplan Commercial |
$7,335.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,436.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,493.14
|
| Rate for Payer: Quartz Commercial |
$5,501.81
|
| Rate for Payer: WEA Trust Commercial |
$5,043.32
|
| Rate for Payer: WPS Commercial |
$6,791.74
|
|
|
STENT GENESIS 5mm X 14mm PG1550BSS
|
Facility
|
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.51 |
| Max. Negotiated Rate |
$8,436.11 |
| Rate for Payer: Aetna Commercial |
$8,252.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,885.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,567.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,960.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,584.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,401.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,859.93
|
| Rate for Payer: Cash Price |
$2,645.10
|
| Rate for Payer: Cigna Commercial |
$8,436.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,131.49
|
| Rate for Payer: Health EOS Commercial |
$8,161.02
|
| Rate for Payer: HFN Commercial |
$8,436.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,877.26
|
| Rate for Payer: Multiplan Commercial |
$7,335.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,501.81
|
| Rate for Payer: Preferred Network Access Commercial |
$8,436.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,493.14
|
| Rate for Payer: Quartz Commercial |
$5,960.29
|
| Rate for Payer: Quartz Medicare Advantage |
$5,501.81
|
| Rate for Payer: The Alliance Commercial |
$4,584.84
|
| Rate for Payer: WEA Trust Commercial |
$5,043.32
|
| Rate for Payer: WPS Commercial |
$6,791.74
|
|
