|
VIABAHN 5MM X 10CM #VBJ051002
|
Facility
|
OP
|
$19,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,458.60 |
| Max. Negotiated Rate |
$77,980.00 |
| Rate for Payer: Aetna Commercial |
$17,545.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,765.70
|
| Rate for Payer: Aetna Managed Medicare |
$5,458.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,671.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,747.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,357.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,332.35
|
| Rate for Payer: Cash Price |
$5,848.50
|
| Rate for Payer: Cigna Commercial |
$17,935.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,909.40
|
| Rate for Payer: Health EOS Commercial |
$17,350.55
|
| Rate for Payer: HFN Commercial |
$17,935.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,621.25
|
| Rate for Payer: Multiplan Commercial |
$15,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,697.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,935.40
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.55
|
| Rate for Payer: Quartz Commercial |
$12,671.75
|
| Rate for Payer: Quartz Medicare Advantage |
$11,697.00
|
| Rate for Payer: The Alliance Commercial |
$77,980.00
|
| Rate for Payer: WEA Trust Commercial |
$10,722.25
|
| Rate for Payer: WPS Commercial |
$14,439.95
|
|
|
Viabahn 5mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 5mm x 15cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,184.87 |
| Max. Negotiated Rate |
$13,489.96 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$8,797.80
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 5mm x 15cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.72 |
| Max. Negotiated Rate |
$13,929.85 |
| Rate for Payer: Aetna Commercial |
$13,929.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,929.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,331.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,797.80
|
| Rate for Payer: Health EOS Commercial |
$13,343.33
|
| Rate for Payer: HFN Commercial |
$13,929.85
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,929.85
|
| Rate for Payer: Quartz Beloit One Network |
$6,451.72
|
| Rate for Payer: Quartz Commercial |
$8,357.91
|
| Rate for Payer: The Alliance Commercial |
$7,331.50
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 5MM X 15CM #372611
|
Facility
|
IP
|
$23,577.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,552.73 |
| Max. Negotiated Rate |
$21,690.84 |
| Rate for Payer: Aetna Commercial |
$21,219.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,276.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,495.81
|
| Rate for Payer: Cash Price |
$7,073.10
|
| Rate for Payer: Cigna Commercial |
$21,690.84
|
| Rate for Payer: Health EOS Commercial |
$20,983.53
|
| Rate for Payer: HFN Commercial |
$21,690.84
|
| Rate for Payer: Multiplan Commercial |
$18,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,146.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,690.84
|
| Rate for Payer: Quartz Beloit One Network |
$11,552.73
|
| Rate for Payer: Quartz Commercial |
$14,146.20
|
| Rate for Payer: WEA Trust Commercial |
$12,967.35
|
| Rate for Payer: WPS Commercial |
$17,463.48
|
|
|
VIABAHN 5MM X 15CM #372611
|
Facility
|
OP
|
$23,577.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,601.56 |
| Max. Negotiated Rate |
$94,308.00 |
| Rate for Payer: Aetna Commercial |
$21,219.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,276.22
|
| Rate for Payer: Aetna Managed Medicare |
$6,601.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,325.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,788.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,316.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,495.81
|
| Rate for Payer: Cash Price |
$7,073.10
|
| Rate for Payer: Cigna Commercial |
$21,690.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,193.69
|
| Rate for Payer: Health EOS Commercial |
$20,983.53
|
| Rate for Payer: HFN Commercial |
$21,690.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,682.75
|
| Rate for Payer: Multiplan Commercial |
$18,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,146.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,690.84
|
| Rate for Payer: Quartz Beloit One Network |
$11,552.73
|
| Rate for Payer: Quartz Commercial |
$15,325.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14,146.20
|
| Rate for Payer: The Alliance Commercial |
$94,308.00
|
| Rate for Payer: WEA Trust Commercial |
$12,967.35
|
| Rate for Payer: WPS Commercial |
$17,463.48
|
|
|
Viabahn 5mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 5mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,184.87 |
| Max. Negotiated Rate |
$13,489.96 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$8,797.80
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 5mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.72 |
| Max. Negotiated Rate |
$13,929.85 |
| Rate for Payer: Aetna Commercial |
$13,929.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,929.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,331.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,797.80
|
| Rate for Payer: Health EOS Commercial |
$13,343.33
|
| Rate for Payer: HFN Commercial |
$13,929.85
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,929.85
|
| Rate for Payer: Quartz Beloit One Network |
$6,451.72
|
| Rate for Payer: Quartz Commercial |
$8,357.91
|
| Rate for Payer: The Alliance Commercial |
$7,331.50
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 5mm x 5cm #VBJ050502
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,775.12 |
| Max. Negotiated Rate |
$68,216.00 |
| Rate for Payer: Aetna Commercial |
$15,348.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,666.44
|
| Rate for Payer: Aetna Managed Medicare |
$4,775.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,085.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,527.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,185.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,038.62
|
| Rate for Payer: Cash Price |
$5,116.20
|
| Rate for Payer: Cigna Commercial |
$15,689.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,543.42
|
| Rate for Payer: Health EOS Commercial |
$15,178.06
|
| Rate for Payer: HFN Commercial |
$15,689.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,790.50
|
| Rate for Payer: Multiplan Commercial |
$13,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,689.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,356.46
|
| Rate for Payer: Quartz Commercial |
$11,085.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,232.40
|
| Rate for Payer: The Alliance Commercial |
$68,216.00
|
| Rate for Payer: WEA Trust Commercial |
$9,379.70
|
| Rate for Payer: WPS Commercial |
$12,631.90
|
|
|
VIABAHN 5mm x 5cm #VBJ050502
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,356.46 |
| Max. Negotiated Rate |
$15,689.68 |
| Rate for Payer: Aetna Commercial |
$15,348.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,666.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,038.62
|
| Rate for Payer: Cash Price |
$5,116.20
|
| Rate for Payer: Cigna Commercial |
$15,689.68
|
| Rate for Payer: Health EOS Commercial |
$15,178.06
|
| Rate for Payer: HFN Commercial |
$15,689.68
|
| Rate for Payer: Multiplan Commercial |
$13,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,689.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,356.46
|
| Rate for Payer: Quartz Commercial |
$10,232.40
|
| Rate for Payer: WEA Trust Commercial |
$9,379.70
|
| Rate for Payer: WPS Commercial |
$12,631.90
|
|
|
Viabahn 6mm x 10cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 10cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.72 |
| Max. Negotiated Rate |
$13,929.85 |
| Rate for Payer: Aetna Commercial |
$13,929.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,929.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,331.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,797.80
|
| Rate for Payer: Health EOS Commercial |
$13,343.33
|
| Rate for Payer: HFN Commercial |
$13,929.85
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,929.85
|
| Rate for Payer: Quartz Beloit One Network |
$6,451.72
|
| Rate for Payer: Quartz Commercial |
$8,357.91
|
| Rate for Payer: The Alliance Commercial |
$7,331.50
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 10cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,184.87 |
| Max. Negotiated Rate |
$13,489.96 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$8,797.80
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 6MM X 10CM #VBJ061002
|
Facility
|
OP
|
$20,720.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,801.60 |
| Max. Negotiated Rate |
$82,880.00 |
| Rate for Payer: Aetna Commercial |
$18,648.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,819.20
|
| Rate for Payer: Aetna Managed Medicare |
$5,801.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,468.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,360.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,945.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,981.60
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cigna Commercial |
$19,062.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,594.91
|
| Rate for Payer: Health EOS Commercial |
$18,440.80
|
| Rate for Payer: HFN Commercial |
$19,062.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,540.00
|
| Rate for Payer: Multiplan Commercial |
$16,576.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,062.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,152.80
|
| Rate for Payer: Quartz Commercial |
$13,468.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12,432.00
|
| Rate for Payer: The Alliance Commercial |
$82,880.00
|
| Rate for Payer: WEA Trust Commercial |
$11,396.00
|
| Rate for Payer: WPS Commercial |
$15,347.30
|
|
|
VIABAHN 6MM X 10CM #VBJ061002
|
Facility
|
IP
|
$20,720.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973931
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,152.80 |
| Max. Negotiated Rate |
$19,062.40 |
| Rate for Payer: Aetna Commercial |
$18,648.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,819.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,981.60
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cigna Commercial |
$19,062.40
|
| Rate for Payer: Health EOS Commercial |
$18,440.80
|
| Rate for Payer: HFN Commercial |
$19,062.40
|
| Rate for Payer: Multiplan Commercial |
$16,576.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,062.40
|
| Rate for Payer: Quartz Beloit One Network |
$10,152.80
|
| Rate for Payer: Quartz Commercial |
$12,432.00
|
| Rate for Payer: WEA Trust Commercial |
$11,396.00
|
| Rate for Payer: WPS Commercial |
$15,347.30
|
|
|
Viabahn 6mm x 15cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.72 |
| Max. Negotiated Rate |
$13,929.85 |
| Rate for Payer: Aetna Commercial |
$13,929.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,929.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,331.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,797.80
|
| Rate for Payer: Health EOS Commercial |
$13,343.33
|
| Rate for Payer: HFN Commercial |
$13,929.85
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,929.85
|
| Rate for Payer: Quartz Beloit One Network |
$6,451.72
|
| Rate for Payer: Quartz Commercial |
$8,357.91
|
| Rate for Payer: The Alliance Commercial |
$7,331.50
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 15cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,184.87 |
| Max. Negotiated Rate |
$13,489.96 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$8,797.80
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 6mm x 15cm #VBJ061502
|
Facility
|
OP
|
$23,887.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,688.36 |
| Max. Negotiated Rate |
$95,548.00 |
| Rate for Payer: Aetna Commercial |
$21,498.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,542.82
|
| Rate for Payer: Aetna Managed Medicare |
$6,688.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,526.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,943.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,465.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,660.11
|
| Rate for Payer: Cash Price |
$7,166.10
|
| Rate for Payer: Cigna Commercial |
$21,976.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,367.17
|
| Rate for Payer: Health EOS Commercial |
$21,259.43
|
| Rate for Payer: HFN Commercial |
$21,976.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,915.25
|
| Rate for Payer: Multiplan Commercial |
$19,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,332.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,976.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,704.63
|
| Rate for Payer: Quartz Commercial |
$15,526.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14,332.20
|
| Rate for Payer: The Alliance Commercial |
$95,548.00
|
| Rate for Payer: WEA Trust Commercial |
$13,137.85
|
| Rate for Payer: WPS Commercial |
$17,693.10
|
|
|
VIABAHN 6mm x 15cm #VBJ061502
|
Facility
|
IP
|
$23,887.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,704.63 |
| Max. Negotiated Rate |
$21,976.04 |
| Rate for Payer: Aetna Commercial |
$21,498.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,542.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,660.11
|
| Rate for Payer: Cash Price |
$7,166.10
|
| Rate for Payer: Cigna Commercial |
$21,976.04
|
| Rate for Payer: Health EOS Commercial |
$21,259.43
|
| Rate for Payer: HFN Commercial |
$21,976.04
|
| Rate for Payer: Multiplan Commercial |
$19,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,332.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,976.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,704.63
|
| Rate for Payer: Quartz Commercial |
$14,332.20
|
| Rate for Payer: WEA Trust Commercial |
$13,137.85
|
| Rate for Payer: WPS Commercial |
$17,693.10
|
|
|
Viabahn 6mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.72 |
| Max. Negotiated Rate |
$13,929.85 |
| Rate for Payer: Aetna Commercial |
$13,929.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,929.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,331.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,797.80
|
| Rate for Payer: Health EOS Commercial |
$13,343.33
|
| Rate for Payer: HFN Commercial |
$13,929.85
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,929.85
|
| Rate for Payer: Quartz Beloit One Network |
$6,451.72
|
| Rate for Payer: Quartz Commercial |
$8,357.91
|
| Rate for Payer: The Alliance Commercial |
$7,331.50
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,184.87 |
| Max. Negotiated Rate |
$13,489.96 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$8,797.80
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 6mm X 5cm #VBJ060502
|
Facility
|
OP
|
$17,710.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,958.80 |
| Max. Negotiated Rate |
$70,840.00 |
| Rate for Payer: Aetna Commercial |
$15,939.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,230.60
|
| Rate for Payer: Aetna Managed Medicare |
$4,958.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,511.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,855.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,500.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,386.30
|
| Rate for Payer: Cash Price |
$5,313.00
|
| Rate for Payer: Cigna Commercial |
$16,293.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,910.52
|
| Rate for Payer: Health EOS Commercial |
$15,761.90
|
| Rate for Payer: HFN Commercial |
$16,293.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,282.50
|
| Rate for Payer: Multiplan Commercial |
$14,168.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,626.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,293.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,677.90
|
| Rate for Payer: Quartz Commercial |
$11,511.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10,626.00
|
| Rate for Payer: The Alliance Commercial |
$70,840.00
|
| Rate for Payer: WEA Trust Commercial |
$9,740.50
|
| Rate for Payer: WPS Commercial |
$13,117.80
|
|
