|
STENT GENESIS 5mm X 17mm PG1850BSS
|
Facility
|
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974851
|
|
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
|
|
|
STENT GENESIS 5mm X 17mm PG1850BSS
|
Facility
|
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974851
|
|
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 5 X 14mm PG1550BAX
|
Facility
|
OP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974854
|
|
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 5 X 14mm PG1550BAX
|
Facility
|
IP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974854
|
|
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 5 X 17mm PG1850BAX
|
Facility
|
IP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974853
|
|
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 5 X 17mm PG1850BAX
|
Facility
|
OP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974853
|
|
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 6mm X 14mm PG1560BSS
|
Facility
|
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974848
|
|
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
|
|
|
STENT GENESIS 6mm X 14mm PG1560BSS
|
Facility
|
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974848
|
|
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 6mm X 17mm PG1860BSS
|
Facility
|
OP
|
$9,567.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,785.91 |
| Max. Negotiated Rate |
$9,153.71 |
| Rate for Payer: Aetna Commercial |
$8,954.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,556.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,785.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,467.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,974.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,775.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,273.33
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cigna Commercial |
$9,153.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,567.99
|
| Rate for Payer: Health EOS Commercial |
$8,855.22
|
| Rate for Payer: HFN Commercial |
$9,153.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,462.26
|
| Rate for Payer: Multiplan Commercial |
$7,959.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,969.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,153.71
|
| Rate for Payer: Quartz Beloit One Network |
$4,875.34
|
| Rate for Payer: Quartz Commercial |
$6,467.29
|
| Rate for Payer: Quartz Medicare Advantage |
$5,969.81
|
| Rate for Payer: The Alliance Commercial |
$4,974.84
|
| Rate for Payer: WEA Trust Commercial |
$5,472.32
|
| Rate for Payer: WPS Commercial |
$7,369.46
|
|
|
STENT GENESIS 6mm X 17mm PG1860BSS
|
Facility
|
IP
|
$9,567.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.34 |
| Max. Negotiated Rate |
$9,153.71 |
| Rate for Payer: Aetna Commercial |
$8,954.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,556.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,273.33
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cigna Commercial |
$9,153.71
|
| Rate for Payer: Health EOS Commercial |
$8,855.22
|
| Rate for Payer: HFN Commercial |
$9,153.71
|
| Rate for Payer: Multiplan Commercial |
$7,959.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,153.71
|
| Rate for Payer: Quartz Beloit One Network |
$4,875.34
|
| Rate for Payer: Quartz Commercial |
$5,969.81
|
| Rate for Payer: WEA Trust Commercial |
$5,472.32
|
| Rate for Payer: WPS Commercial |
$7,369.46
|
|
|
STENT GENESIS 6 x 13mm PG1560BAX
|
Facility
|
OP
|
$7,448.00
|
|
| Hospital Charge Code |
2974850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.86 |
| Max. Negotiated Rate |
$7,126.25 |
| Rate for Payer: Aetna Commercial |
$6,971.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,661.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,168.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,034.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,872.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,718.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,105.34
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cigna Commercial |
$7,126.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,334.74
|
| Rate for Payer: Health EOS Commercial |
$6,893.87
|
| Rate for Payer: HFN Commercial |
$7,126.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,809.44
|
| Rate for Payer: Multiplan Commercial |
$6,196.74
|
| Rate for Payer: NAPHCARE Commercial |
$4,647.55
|
| Rate for Payer: Preferred Network Access Commercial |
$7,126.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,795.50
|
| Rate for Payer: Quartz Commercial |
$5,034.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,647.55
|
| Rate for Payer: The Alliance Commercial |
$3,872.96
|
| Rate for Payer: WEA Trust Commercial |
$4,260.26
|
| Rate for Payer: WPS Commercial |
$5,737.19
|
|
|
STENT GENESIS 6 x 13mm PG1560BAX
|
Facility
|
IP
|
$7,448.00
|
|
| Hospital Charge Code |
2974850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.50 |
| Max. Negotiated Rate |
$7,126.25 |
| Rate for Payer: Aetna Commercial |
$6,971.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,661.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,105.34
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cigna Commercial |
$7,126.25
|
| Rate for Payer: Health EOS Commercial |
$6,893.87
|
| Rate for Payer: HFN Commercial |
$7,126.25
|
| Rate for Payer: Multiplan Commercial |
$6,196.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,126.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,795.50
|
| Rate for Payer: Quartz Commercial |
$4,647.55
|
| Rate for Payer: WEA Trust Commercial |
$4,260.26
|
| Rate for Payer: WPS Commercial |
$5,737.19
|
|
|
STENT GENESIS 6 X 15mm PG1860BAX
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.88 |
| Max. Negotiated Rate |
$1,773.91 |
| Rate for Payer: Aetna Commercial |
$1,735.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,658.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,253.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$964.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.92
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$1,773.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,079.03
|
| Rate for Payer: Health EOS Commercial |
$1,716.06
|
| Rate for Payer: HFN Commercial |
$1,773.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,446.12
|
| Rate for Payer: Multiplan Commercial |
$1,542.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,773.91
|
| Rate for Payer: Quartz Beloit One Network |
$944.80
|
| Rate for Payer: Quartz Commercial |
$1,253.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.90
|
| Rate for Payer: The Alliance Commercial |
$964.08
|
| Rate for Payer: WEA Trust Commercial |
$1,060.49
|
| Rate for Payer: WPS Commercial |
$1,428.14
|
|
|
STENT GENESIS 6 X 15mm PG1860BAX
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.80 |
| Max. Negotiated Rate |
$1,773.91 |
| Rate for Payer: Aetna Commercial |
$1,735.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,658.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.92
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$1,773.91
|
| Rate for Payer: Health EOS Commercial |
$1,716.06
|
| Rate for Payer: HFN Commercial |
$1,773.91
|
| Rate for Payer: Multiplan Commercial |
$1,542.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,773.91
|
| Rate for Payer: Quartz Beloit One Network |
$944.80
|
| Rate for Payer: Quartz Commercial |
$1,156.90
|
| Rate for Payer: WEA Trust Commercial |
$1,060.49
|
| Rate for Payer: WPS Commercial |
$1,428.14
|
|
|
STENT GENESIS 7MM X 15MM PG1570BSX
|
Facility
|
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974845
|
|
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
|
|
|
STENT GENESIS 7MM X 15MM PG1570BSX
|
Facility
|
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974845
|
|
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 7mm x 17mm PG1870BAX
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,216.94 |
| Max. Negotiated Rate |
$7,917.52 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,482.50
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.23
|
|
|
STENT GENESIS 7mm x 17mm PG1870BAX
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.68 |
| Max. Negotiated Rate |
$7,917.52 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,409.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,593.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,303.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,130.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,482.50
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,816.05
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,454.50
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,593.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,163.60
|
| Rate for Payer: The Alliance Commercial |
$4,303.00
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.23
|
|
|
STENT GENESIS 7MM X 18MM PG1870BSX
|
Facility
|
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974843
|
|
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 7MM X 18MM PG1870BSX
|
Facility
|
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974843
|
|
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
|
|
|
STENT GENESIS 7 X 14mm PG1570BAX
|
Facility
|
IP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974846
|
|
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 7 X 14mm PG1570BAX
|
Facility
|
OP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974846
|
|
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 GRAFT 3.0 x 12mm JOS #12744-12
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT GRAFT 3.0 x 12mm JOS #12744-12
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT GRAFT 3.0 x 16mm JOS #12744-16
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
