|
STENT TRIA FIRM WITH SIDE HOLES 6 X 30 M0061902250
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
6169845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 30 M0061902250
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
6169845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 20 M0061903200
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 20 M0061903200
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 22 M0061903210
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 22 M0061903210
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 24 M0061903220
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5547375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 24 M0061903220
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5547375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 26 M0061903230
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5641677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 26 M0061903230
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5641677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 28 M0061903240
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5641678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 28 M0061903240
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5641678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 30 M0061903250
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5861682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT TRIA SOFT WITH SIDE HOLES 6 X 30 M0061903250
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5861682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,282.94
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
|
STENT URETERAL 6X28 FIRM G49907
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT URETERAL 6X28 FIRM G49907
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
Stent Venous
|
Facility
|
IP
|
$5,572.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
4125709
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,839.49 |
| Max. Negotiated Rate |
$5,331.29 |
| Rate for Payer: Aetna Commercial |
$5,215.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.29
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,331.29
|
| Rate for Payer: Health EOS Commercial |
$5,157.44
|
| Rate for Payer: HFN Commercial |
$5,331.29
|
| Rate for Payer: Multiplan Commercial |
$4,635.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.49
|
| Rate for Payer: Quartz Commercial |
$3,476.93
|
| Rate for Payer: WEA Trust Commercial |
$3,187.18
|
| Rate for Payer: WPS Commercial |
$4,292.11
|
|
|
Stent Venous
|
Facility
|
OP
|
$5,572.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
4125709
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,839.49 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$5,215.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.60
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| 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: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,331.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$5,157.44
|
| Rate for Payer: HFN Commercial |
$5,331.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$4,635.90
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.49
|
| Rate for Payer: Quartz Commercial |
$3,766.67
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$3,187.18
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$4,292.11
|
|
|
Stent Venous ea add +
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
4125710
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
Stent Venous ea add +
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
4125710
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$488.09 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$488.09
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
STENT VERIFLEX 3.0 X 28MM
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 3.0 X 28MM
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 12
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 12
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 16
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
