|
STENT VERIFLEX 4.0 X 16
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974797
|
|
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 20
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974796
|
|
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 20
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974796
|
|
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 BARE 3.5 X 8MM
|
Facility
|
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2974795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,306.85 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,306.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,998.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,690.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,383.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,607.78
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,536.20
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: NAPHCARE Commercial |
$9,228.96
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,998.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9,228.96
|
| Rate for Payer: The Alliance Commercial |
$7,690.80
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STENT VERIFLEX BARE 3.5 X 8MM
|
Facility
|
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2974795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,536.98 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,228.96
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STENT VISION 3.0 x 12mm #1007848-12
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 12mm #1007848-12
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 18mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 18mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 28mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 28mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 12mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 12mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 18mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 18mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 28mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 28mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION MULTI-LINK 4.0 x 12mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION MULTI-LINK 4.0 x 12mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION MULTI-LINK 4.0 x 18mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION MULTI-LINK 4.0 x 18mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISI-PRO 7mm X 27mm X135 #PXB35-07-27-135
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2974786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,939.04 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,047.81
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
STENT VISI-PRO 7mm X 27mm X135 #PXB35-07-27-135
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2974786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
STENT VISIPRO 7 X 12 #PXB35-07-12-80
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,035.36 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,165.74
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
|
STENT VISIPRO 7 X 12 #PXB35-07-12-80
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.35 |
| Max. Negotiated Rate |
$9,454.14 |
| Rate for Payer: Aetna Commercial |
$9,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,837.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,877.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,679.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,138.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,932.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,446.41
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,454.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,750.74
|
| Rate for Payer: Health EOS Commercial |
$9,145.85
|
| Rate for Payer: HFN Commercial |
$9,454.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,707.18
|
| Rate for Payer: Multiplan Commercial |
$8,220.99
|
| Rate for Payer: NAPHCARE Commercial |
$6,165.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,454.14
|
| Rate for Payer: Quartz Beloit One Network |
$5,035.36
|
| Rate for Payer: Quartz Commercial |
$6,679.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6,165.74
|
| Rate for Payer: The Alliance Commercial |
$5,138.12
|
| Rate for Payer: WEA Trust Commercial |
$5,651.93
|
| Rate for Payer: WPS Commercial |
$7,611.33
|
|
