|
STENT METALLIC 6X24 URETERAL G34110
|
Facility
|
OP
|
$8,574.00
|
|
| Hospital Charge Code |
2964979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.75 |
| Max. Negotiated Rate |
$8,203.60 |
| Rate for Payer: Aetna Commercial |
$8,025.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,668.59
|
| Rate for Payer: Aetna Managed Medicare |
$2,496.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,796.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,458.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,280.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,725.99
|
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cigna Commercial |
$8,203.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,990.07
|
| Rate for Payer: Health EOS Commercial |
$7,936.09
|
| Rate for Payer: HFN Commercial |
$8,203.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,687.72
|
| Rate for Payer: Multiplan Commercial |
$7,133.57
|
| Rate for Payer: NAPHCARE Commercial |
$5,350.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,203.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,369.31
|
| Rate for Payer: Quartz Commercial |
$5,796.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,350.18
|
| Rate for Payer: The Alliance Commercial |
$4,458.48
|
| Rate for Payer: WEA Trust Commercial |
$4,904.33
|
| Rate for Payer: WPS Commercial |
$6,604.55
|
|
|
STENT METALLIC 6X24 URETERAL G34110
|
Facility
|
IP
|
$8,574.00
|
|
| Hospital Charge Code |
2964979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,369.31 |
| Max. Negotiated Rate |
$8,203.60 |
| Rate for Payer: Aetna Commercial |
$8,025.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,668.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,725.99
|
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cigna Commercial |
$8,203.60
|
| Rate for Payer: Health EOS Commercial |
$7,936.09
|
| Rate for Payer: HFN Commercial |
$8,203.60
|
| Rate for Payer: Multiplan Commercial |
$7,133.57
|
| Rate for Payer: Preferred Network Access Commercial |
$8,203.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,369.31
|
| Rate for Payer: Quartz Commercial |
$5,350.18
|
| Rate for Payer: WEA Trust Commercial |
$4,904.33
|
| Rate for Payer: WPS Commercial |
$6,604.55
|
|
|
STENT METALLIC 6X28 URETERAL G34112
|
Facility
|
IP
|
$8,256.00
|
|
| Hospital Charge Code |
2964980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,207.26 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,151.74
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6X28 URETERAL G34112
|
Facility
|
OP
|
$8,256.00
|
|
| Hospital Charge Code |
2964980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,404.15 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,404.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,581.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,293.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,804.99
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,439.68
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,151.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,581.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,151.74
|
| Rate for Payer: The Alliance Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6 X 30 URETERAL G34176
|
Facility
|
IP
|
$8,256.00
|
|
| Hospital Charge Code |
2964981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,207.26 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,151.74
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6 X 30 URETERAL G34176
|
Facility
|
OP
|
$8,256.00
|
|
| Hospital Charge Code |
2964981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,404.15 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,404.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,581.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,293.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,804.99
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,439.68
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,151.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,581.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,151.74
|
| Rate for Payer: The Alliance Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
Stent-Palmaz Blue
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4139320
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
Stent-Palmaz Blue
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4139320
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 6MMX 18MM X 135CM
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3082053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 6MMX 18MM X 135CM
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3082053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 15MM PB1570BSX
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 15MM PB1570BSX
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 18MM PB1870BSX
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 18MM PB1870BSX
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PERCUFLEX INTRODUCER 10FR M00533920
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
2972181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.71 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$533.52
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
STENT PERCUFLEX INTRODUCER 10FR M00533920
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
2972181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.98 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Aetna Managed Medicare |
$248.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.61
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: NAPHCARE Commercial |
$533.52
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$577.98
|
| Rate for Payer: Quartz Medicare Advantage |
$533.52
|
| Rate for Payer: The Alliance Commercial |
$444.60
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
STENT PERCUFLEX NEPHROURETERAL 8FR X 24CM NON-COATED M001221370
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5307025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.77 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Aetna Managed Medicare |
$351.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$628.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.06
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.24
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: NAPHCARE Commercial |
$753.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$816.61
|
| Rate for Payer: Quartz Medicare Advantage |
$753.79
|
| Rate for Payer: The Alliance Commercial |
$628.16
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
STENT PERCUFLEX NEPHROURETERAL 8FR X 24CM NON-COATED M001221370
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5307025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$753.79
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
STENT PERCUFLEX NEPHROURETERAL 8FR X 28CM NON-COATED M001221390
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5307026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$753.79
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
STENT PERCUFLEX NEPHROURETERAL 8FR X 28CM NON-COATED M001221390
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5307026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.77 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Aetna Managed Medicare |
$351.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$628.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.06
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.24
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: NAPHCARE Commercial |
$753.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$816.61
|
| Rate for Payer: Quartz Medicare Advantage |
$753.79
|
| Rate for Payer: The Alliance Commercial |
$628.16
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
STENT PERCUFLEX PLUS 4.8 X 18 M0061751990
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5348712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.74 |
| Max. Negotiated Rate |
$1,550.02 |
| Rate for Payer: Aetna Commercial |
$1,516.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.93
|
| Rate for Payer: Aetna Managed Medicare |
$471.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,095.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.94
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$1,550.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.84
|
| Rate for Payer: Health EOS Commercial |
$1,499.47
|
| Rate for Payer: HFN Commercial |
$1,550.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.60
|
| Rate for Payer: Multiplan Commercial |
$1,347.84
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.02
|
| Rate for Payer: Quartz Beloit One Network |
$825.55
|
| Rate for Payer: Quartz Commercial |
$1,095.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,010.88
|
| Rate for Payer: The Alliance Commercial |
$842.40
|
| Rate for Payer: WEA Trust Commercial |
$926.64
|
| Rate for Payer: WPS Commercial |
$1,247.89
|
|
|
STENT PERCUFLEX PLUS 4.8 X 18 M0061751990
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5348712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.55 |
| Max. Negotiated Rate |
$1,550.02 |
| Rate for Payer: Aetna Commercial |
$1,516.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.94
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$1,550.02
|
| Rate for Payer: Health EOS Commercial |
$1,499.47
|
| Rate for Payer: HFN Commercial |
$1,550.02
|
| Rate for Payer: Multiplan Commercial |
$1,347.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.02
|
| Rate for Payer: Quartz Beloit One Network |
$825.55
|
| Rate for Payer: Quartz Commercial |
$1,010.88
|
| Rate for Payer: WEA Trust Commercial |
$926.64
|
| Rate for Payer: WPS Commercial |
$1,247.89
|
|
|
STENT PERCUFLEX PLUS 4.8 X 20 M0061752500
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.44 |
| Max. Negotiated Rate |
$1,140.51 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.03
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,140.51
|
| Rate for Payer: Health EOS Commercial |
$1,103.32
|
| Rate for Payer: HFN Commercial |
$1,140.51
|
| Rate for Payer: Multiplan Commercial |
$991.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.51
|
| Rate for Payer: Quartz Beloit One Network |
$607.44
|
| Rate for Payer: Quartz Commercial |
$743.81
|
| Rate for Payer: WEA Trust Commercial |
$681.82
|
| Rate for Payer: WPS Commercial |
$918.20
|
|
|
STENT PERCUFLEX PLUS 4.8 X 20 M0061752500
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$1,140.51 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.12
|
| Rate for Payer: Aetna Managed Medicare |
$347.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$805.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$595.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.03
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,140.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$693.74
|
| Rate for Payer: Health EOS Commercial |
$1,103.32
|
| Rate for Payer: HFN Commercial |
$1,140.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$929.76
|
| Rate for Payer: Multiplan Commercial |
$991.74
|
| Rate for Payer: NAPHCARE Commercial |
$743.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.51
|
| Rate for Payer: Quartz Beloit One Network |
$607.44
|
| Rate for Payer: Quartz Commercial |
$805.79
|
| Rate for Payer: Quartz Medicare Advantage |
$743.81
|
| Rate for Payer: The Alliance Commercial |
$619.84
|
| Rate for Payer: WEA Trust Commercial |
$681.82
|
| Rate for Payer: WPS Commercial |
$918.20
|
|
|
STENT PERCUFLEX PLUS 4.8 X 22 M0061752510
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.44 |
| Max. Negotiated Rate |
$1,140.51 |
| Rate for Payer: Aetna Commercial |
$1,115.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.03
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,140.51
|
| Rate for Payer: Health EOS Commercial |
$1,103.32
|
| Rate for Payer: HFN Commercial |
$1,140.51
|
| Rate for Payer: Multiplan Commercial |
$991.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.51
|
| Rate for Payer: Quartz Beloit One Network |
$607.44
|
| Rate for Payer: Quartz Commercial |
$743.81
|
| Rate for Payer: WEA Trust Commercial |
$681.82
|
| Rate for Payer: WPS Commercial |
$918.20
|
|
