|
STENT RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$260.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$447.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.47
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.88
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$605.70
|
| Rate for Payer: Quartz Medicare Advantage |
$559.10
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$559.10
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$260.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$447.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.47
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.88
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$605.70
|
| Rate for Payer: Quartz Medicare Advantage |
$559.10
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$559.10
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RXBILIARY 10FR 5CM #4560
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RXBILIARY 10FR 5CM #4560
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RXBILIARY 10fr x 12cm
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RXBILIARY 10fr x 12cm
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RXBILIARY 10fr x 7cm
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RXBILIARY 10fr x 7cm
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
|
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
|
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 7FR. 7CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 7FR. 7CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 8.5FR. 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 8.5FR. 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 8.5FR. 12CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 8.5FR. 12CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT RX BILIARY 8.5FR. 5CM
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
