|
VIABAHN 6mm X 5cm #VBJ060502
|
Facility
|
IP
|
$17,710.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,677.90 |
| Max. Negotiated Rate |
$16,293.20 |
| Rate for Payer: Aetna Commercial |
$15,939.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,230.60
|
| 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: Health EOS Commercial |
$15,761.90
|
| Rate for Payer: HFN Commercial |
$16,293.20
|
| 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 |
$10,626.00
|
| Rate for Payer: WEA Trust Commercial |
$9,740.50
|
| Rate for Payer: WPS Commercial |
$13,117.80
|
|
|
Viabahn 7mm x 10cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549080
|
|
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 7mm x 10cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549080
|
|
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 7mm x 10cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549080
|
|
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 7mm X 10cm VBHR071002A
|
Facility
|
OP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.00 |
| Max. Negotiated Rate |
$73,100.00 |
| Rate for Payer: Aetna Commercial |
$16,447.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,716.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,117.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,878.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,772.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,685.75
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$16,813.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,226.69
|
| Rate for Payer: Health EOS Commercial |
$16,264.75
|
| Rate for Payer: HFN Commercial |
$16,813.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,706.25
|
| Rate for Payer: Multiplan Commercial |
$14,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,965.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,813.00
|
| Rate for Payer: Quartz Beloit One Network |
$8,954.75
|
| Rate for Payer: Quartz Commercial |
$11,878.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10,965.00
|
| Rate for Payer: The Alliance Commercial |
$73,100.00
|
| Rate for Payer: WEA Trust Commercial |
$10,051.25
|
| Rate for Payer: WPS Commercial |
$13,536.29
|
|
|
VIABAHN 7mm X 10cm VBHR071002A
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,954.75 |
| Max. Negotiated Rate |
$16,813.00 |
| Rate for Payer: Aetna Commercial |
$16,447.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,716.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,685.75
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$16,813.00
|
| Rate for Payer: Health EOS Commercial |
$16,264.75
|
| Rate for Payer: HFN Commercial |
$16,813.00
|
| Rate for Payer: Multiplan Commercial |
$14,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,965.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,813.00
|
| Rate for Payer: Quartz Beloit One Network |
$8,954.75
|
| Rate for Payer: Quartz Commercial |
$10,965.00
|
| Rate for Payer: WEA Trust Commercial |
$10,051.25
|
| Rate for Payer: WPS Commercial |
$13,536.29
|
|
|
Viabahn 7mm x 15cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549082
|
|
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 7mm x 15cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549082
|
|
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 7mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549082
|
|
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 7mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549078
|
|
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 7mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549078
|
|
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 7mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549078
|
|
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 7mm X 5CM #VBH070502
|
Facility
|
IP
|
$15,652.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,669.48 |
| Max. Negotiated Rate |
$14,399.84 |
| Rate for Payer: Aetna Commercial |
$14,086.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,460.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,295.56
|
| Rate for Payer: Cash Price |
$4,695.60
|
| Rate for Payer: Cigna Commercial |
$14,399.84
|
| Rate for Payer: Health EOS Commercial |
$13,930.28
|
| Rate for Payer: HFN Commercial |
$14,399.84
|
| Rate for Payer: Multiplan Commercial |
$12,521.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,399.84
|
| Rate for Payer: Quartz Beloit One Network |
$7,669.48
|
| Rate for Payer: Quartz Commercial |
$9,391.20
|
| Rate for Payer: WEA Trust Commercial |
$8,608.60
|
| Rate for Payer: WPS Commercial |
$11,593.44
|
|
|
VIABAHN 7mm X 5CM #VBH070502
|
Facility
|
OP
|
$15,652.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,382.56 |
| Max. Negotiated Rate |
$62,608.00 |
| Rate for Payer: Aetna Commercial |
$14,086.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,460.72
|
| Rate for Payer: Aetna Managed Medicare |
$4,382.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,173.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,826.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,512.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,295.56
|
| Rate for Payer: Cash Price |
$4,695.60
|
| Rate for Payer: Cigna Commercial |
$14,399.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,758.86
|
| Rate for Payer: Health EOS Commercial |
$13,930.28
|
| Rate for Payer: HFN Commercial |
$14,399.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,739.00
|
| Rate for Payer: Multiplan Commercial |
$12,521.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$14,399.84
|
| Rate for Payer: Quartz Beloit One Network |
$7,669.48
|
| Rate for Payer: Quartz Commercial |
$10,173.80
|
| Rate for Payer: Quartz Medicare Advantage |
$9,391.20
|
| Rate for Payer: The Alliance Commercial |
$62,608.00
|
| Rate for Payer: WEA Trust Commercial |
$8,608.60
|
| Rate for Payer: WPS Commercial |
$11,593.44
|
|
|
VIAHAHN 7mm X 15CM #VBH071502
|
Facility
|
OP
|
$21,721.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,081.88 |
| Max. Negotiated Rate |
$86,884.00 |
| Rate for Payer: Aetna Commercial |
$19,548.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.06
|
| Rate for Payer: Aetna Managed Medicare |
$6,081.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,118.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,860.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,426.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.13
|
| Rate for Payer: Cash Price |
$6,516.30
|
| Rate for Payer: Cigna Commercial |
$19,983.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,155.07
|
| Rate for Payer: Health EOS Commercial |
$19,331.69
|
| Rate for Payer: HFN Commercial |
$19,983.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,290.75
|
| Rate for Payer: Multiplan Commercial |
$17,376.80
|
| Rate for Payer: NAPHCARE Commercial |
$13,032.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.29
|
| Rate for Payer: Quartz Commercial |
$14,118.65
|
| Rate for Payer: Quartz Medicare Advantage |
$13,032.60
|
| Rate for Payer: The Alliance Commercial |
$86,884.00
|
| Rate for Payer: WEA Trust Commercial |
$11,946.55
|
| Rate for Payer: WPS Commercial |
$16,088.74
|
|
|
VIAHAHN 7mm X 15CM #VBH071502
|
Facility
|
IP
|
$21,721.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,643.29 |
| Max. Negotiated Rate |
$19,983.32 |
| Rate for Payer: Aetna Commercial |
$19,548.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.13
|
| Rate for Payer: Cash Price |
$6,516.30
|
| Rate for Payer: Cigna Commercial |
$19,983.32
|
| Rate for Payer: Health EOS Commercial |
$19,331.69
|
| Rate for Payer: HFN Commercial |
$19,983.32
|
| Rate for Payer: Multiplan Commercial |
$17,376.80
|
| Rate for Payer: NAPHCARE Commercial |
$13,032.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.29
|
| Rate for Payer: Quartz Commercial |
$13,032.60
|
| Rate for Payer: WEA Trust Commercial |
$11,946.55
|
| Rate for Payer: WPS Commercial |
$16,088.74
|
|
|
Viance CTO Catheter
|
Facility
|
OP
|
$11,539.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,230.92 |
| Max. Negotiated Rate |
$46,156.00 |
| Rate for Payer: Aetna Commercial |
$10,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,923.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,230.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,500.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,538.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,115.67
|
| Rate for Payer: Cash Price |
$3,461.70
|
| Rate for Payer: Cigna Commercial |
$10,615.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,457.22
|
| Rate for Payer: Health EOS Commercial |
$10,269.71
|
| Rate for Payer: HFN Commercial |
$10,615.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,654.25
|
| Rate for Payer: Multiplan Commercial |
$9,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,615.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,654.11
|
| Rate for Payer: Quartz Commercial |
$7,500.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6,923.40
|
| Rate for Payer: The Alliance Commercial |
$46,156.00
|
| Rate for Payer: WEA Trust Commercial |
$6,346.45
|
| Rate for Payer: WPS Commercial |
$8,546.94
|
|
|
Viance CTO Catheter
|
Facility
|
IP
|
$11,539.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,654.11 |
| Max. Negotiated Rate |
$10,615.88 |
| Rate for Payer: Aetna Commercial |
$10,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,923.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,115.67
|
| Rate for Payer: Cash Price |
$3,461.70
|
| Rate for Payer: Cigna Commercial |
$10,615.88
|
| Rate for Payer: Health EOS Commercial |
$10,269.71
|
| Rate for Payer: HFN Commercial |
$10,615.88
|
| Rate for Payer: Multiplan Commercial |
$9,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,615.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,654.11
|
| Rate for Payer: Quartz Commercial |
$6,923.40
|
| Rate for Payer: WEA Trust Commercial |
$6,346.45
|
| Rate for Payer: WPS Commercial |
$8,546.94
|
|
|
Vibration
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989708
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Vibration
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989708
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$104.25
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
VIDEO PRINT FEE
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2962810
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
VIDEO PRINT FEE
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2962810
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Viperwire Fex .014
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5184613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.24 |
| Max. Negotiated Rate |
$2,277.92 |
| Rate for Payer: Aetna Commercial |
$2,228.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,129.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,312.28
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,277.92
|
| Rate for Payer: Health EOS Commercial |
$2,203.64
|
| Rate for Payer: HFN Commercial |
$2,277.92
|
| Rate for Payer: Multiplan Commercial |
$1,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,213.24
|
| Rate for Payer: Quartz Commercial |
$1,485.60
|
| Rate for Payer: WEA Trust Commercial |
$1,361.80
|
| Rate for Payer: WPS Commercial |
$1,833.97
|
|
|
Viperwire Fex .014
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5184613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.28 |
| Max. Negotiated Rate |
$9,904.00 |
| Rate for Payer: Aetna Commercial |
$2,228.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,129.36
|
| Rate for Payer: Aetna Managed Medicare |
$693.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,238.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,312.28
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,277.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,385.57
|
| Rate for Payer: Health EOS Commercial |
$2,203.64
|
| Rate for Payer: HFN Commercial |
$2,277.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,857.00
|
| Rate for Payer: Multiplan Commercial |
$1,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,213.24
|
| Rate for Payer: Quartz Commercial |
$1,609.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,485.60
|
| Rate for Payer: The Alliance Commercial |
$9,904.00
|
| Rate for Payer: WEA Trust Commercial |
$1,361.80
|
| Rate for Payer: WPS Commercial |
$1,833.97
|
|
|
Viral Culture, Non Respiratory Body Fluids
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
983433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.39 |
| Max. Negotiated Rate |
$378.12 |
| Rate for Payer: Aetna Commercial |
$369.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.83
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$378.12
|
| Rate for Payer: Health EOS Commercial |
$365.79
|
| Rate for Payer: HFN Commercial |
$378.12
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: NAPHCARE Commercial |
$246.60
|
| Rate for Payer: Preferred Network Access Commercial |
$378.12
|
| Rate for Payer: Quartz Beloit One Network |
$201.39
|
| Rate for Payer: Quartz Commercial |
$246.60
|
| Rate for Payer: WEA Trust Commercial |
$226.05
|
| Rate for Payer: WPS Commercial |
$304.43
|
|
