|
VIABAHN 5MM X 10CM #VBJ051002
|
Facility
|
IP
|
$19,495.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,934.65 |
| Max. Negotiated Rate |
$18,652.82 |
| Rate for Payer: Aetna Commercial |
$18,247.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,436.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,745.64
|
| Rate for Payer: Cash Price |
$5,848.50
|
| Rate for Payer: Cigna Commercial |
$18,652.82
|
| Rate for Payer: Health EOS Commercial |
$18,044.57
|
| Rate for Payer: HFN Commercial |
$18,652.82
|
| Rate for Payer: Multiplan Commercial |
$16,219.84
|
| Rate for Payer: Preferred Network Access Commercial |
$18,652.82
|
| Rate for Payer: Quartz Beloit One Network |
$9,934.65
|
| Rate for Payer: Quartz Commercial |
$12,164.88
|
| Rate for Payer: WEA Trust Commercial |
$11,151.14
|
| Rate for Payer: WPS Commercial |
$15,017.00
|
|
|
Viabahn 5mm x 15cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,472.26 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,149.71
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 5mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,269.87 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,269.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,912.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,624.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,319.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,533.87
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,437.14
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: NAPHCARE Commercial |
$9,149.71
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,912.19
|
| Rate for Payer: Quartz Medicare Advantage |
$9,149.71
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 5mm x 15cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,709.79 |
| Max. Negotiated Rate |
$14,487.04 |
| Rate for Payer: Aetna Commercial |
$14,487.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,487.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,624.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,149.71
|
| Rate for Payer: Health EOS Commercial |
$13,877.06
|
| Rate for Payer: HFN Commercial |
$14,487.04
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,487.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,709.79
|
| Rate for Payer: Quartz Commercial |
$8,692.23
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
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 |
$12,014.84 |
| Max. Negotiated Rate |
$22,558.47 |
| Rate for Payer: Aetna Commercial |
$22,068.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,087.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,995.64
|
| Rate for Payer: Cash Price |
$7,073.10
|
| Rate for Payer: Cigna Commercial |
$22,558.47
|
| Rate for Payer: Health EOS Commercial |
$21,822.87
|
| Rate for Payer: HFN Commercial |
$22,558.47
|
| Rate for Payer: Multiplan Commercial |
$19,616.06
|
| Rate for Payer: Preferred Network Access Commercial |
$22,558.47
|
| Rate for Payer: Quartz Beloit One Network |
$12,014.84
|
| Rate for Payer: Quartz Commercial |
$14,712.05
|
| Rate for Payer: WEA Trust Commercial |
$13,486.04
|
| Rate for Payer: WPS Commercial |
$18,161.36
|
|
|
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 |
$6,865.62 |
| Max. Negotiated Rate |
$22,558.47 |
| Rate for Payer: Aetna Commercial |
$22,068.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,087.27
|
| Rate for Payer: Aetna Managed Medicare |
$6,865.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,938.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,260.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,769.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,995.64
|
| Rate for Payer: Cash Price |
$7,073.10
|
| Rate for Payer: Cigna Commercial |
$22,558.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,721.81
|
| Rate for Payer: Health EOS Commercial |
$21,822.87
|
| Rate for Payer: HFN Commercial |
$22,558.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,390.06
|
| Rate for Payer: Multiplan Commercial |
$19,616.06
|
| Rate for Payer: NAPHCARE Commercial |
$14,712.05
|
| Rate for Payer: Preferred Network Access Commercial |
$22,558.47
|
| Rate for Payer: Quartz Beloit One Network |
$12,014.84
|
| Rate for Payer: Quartz Commercial |
$15,938.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14,712.05
|
| Rate for Payer: The Alliance Commercial |
$12,260.04
|
| Rate for Payer: WEA Trust Commercial |
$13,486.04
|
| Rate for Payer: WPS Commercial |
$18,161.36
|
|
|
Viabahn 5mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,269.87 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,269.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,912.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,624.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,319.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,533.87
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,437.14
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: NAPHCARE Commercial |
$9,149.71
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,912.19
|
| Rate for Payer: Quartz Medicare Advantage |
$9,149.71
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 5mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,472.26 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,149.71
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 5mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,709.79 |
| Max. Negotiated Rate |
$14,487.04 |
| Rate for Payer: Aetna Commercial |
$14,487.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,487.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,624.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,149.71
|
| Rate for Payer: Health EOS Commercial |
$13,877.06
|
| Rate for Payer: HFN Commercial |
$14,487.04
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,487.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,709.79
|
| Rate for Payer: Quartz Commercial |
$8,692.23
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
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 |
$4,966.12 |
| Max. Negotiated Rate |
$16,317.27 |
| Rate for Payer: Aetna Commercial |
$15,962.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,253.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,966.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,528.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,868.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,513.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,400.16
|
| Rate for Payer: Cash Price |
$5,116.20
|
| Rate for Payer: Cigna Commercial |
$16,317.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,925.43
|
| Rate for Payer: Health EOS Commercial |
$15,785.18
|
| Rate for Payer: HFN Commercial |
$16,317.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,302.12
|
| Rate for Payer: Multiplan Commercial |
$14,188.93
|
| Rate for Payer: NAPHCARE Commercial |
$10,641.70
|
| Rate for Payer: Preferred Network Access Commercial |
$16,317.27
|
| Rate for Payer: Quartz Beloit One Network |
$8,690.72
|
| Rate for Payer: Quartz Commercial |
$11,528.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10,641.70
|
| Rate for Payer: The Alliance Commercial |
$8,868.08
|
| Rate for Payer: WEA Trust Commercial |
$9,754.89
|
| Rate for Payer: WPS Commercial |
$13,136.70
|
|
|
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 |
$8,690.72 |
| Max. Negotiated Rate |
$16,317.27 |
| Rate for Payer: Aetna Commercial |
$15,962.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,253.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,400.16
|
| Rate for Payer: Cash Price |
$5,116.20
|
| Rate for Payer: Cigna Commercial |
$16,317.27
|
| Rate for Payer: Health EOS Commercial |
$15,785.18
|
| Rate for Payer: HFN Commercial |
$16,317.27
|
| Rate for Payer: Multiplan Commercial |
$14,188.93
|
| Rate for Payer: Preferred Network Access Commercial |
$16,317.27
|
| Rate for Payer: Quartz Beloit One Network |
$8,690.72
|
| Rate for Payer: Quartz Commercial |
$10,641.70
|
| Rate for Payer: WEA Trust Commercial |
$9,754.89
|
| Rate for Payer: WPS Commercial |
$13,136.70
|
|
|
Viabahn 6mm x 10cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,269.87 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,269.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,912.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,624.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,319.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,533.87
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,437.14
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: NAPHCARE Commercial |
$9,149.71
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,912.19
|
| Rate for Payer: Quartz Medicare Advantage |
$9,149.71
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 6mm x 10cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,709.79 |
| Max. Negotiated Rate |
$14,487.04 |
| Rate for Payer: Aetna Commercial |
$14,487.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,487.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,624.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,149.71
|
| Rate for Payer: Health EOS Commercial |
$13,877.06
|
| Rate for Payer: HFN Commercial |
$14,487.04
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,487.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,709.79
|
| Rate for Payer: Quartz Commercial |
$8,692.23
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 6mm x 10cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,472.26 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,149.71
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
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 |
$6,033.66 |
| Max. Negotiated Rate |
$19,824.90 |
| Rate for Payer: Aetna Commercial |
$19,393.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,531.97
|
| Rate for Payer: Aetna Managed Medicare |
$6,033.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,006.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,774.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,343.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,420.86
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cigna Commercial |
$19,824.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,059.04
|
| Rate for Payer: Health EOS Commercial |
$19,178.43
|
| Rate for Payer: HFN Commercial |
$19,824.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,161.60
|
| Rate for Payer: Multiplan Commercial |
$17,239.04
|
| Rate for Payer: NAPHCARE Commercial |
$12,929.28
|
| Rate for Payer: Preferred Network Access Commercial |
$19,824.90
|
| Rate for Payer: Quartz Beloit One Network |
$10,558.91
|
| Rate for Payer: Quartz Commercial |
$14,006.72
|
| Rate for Payer: Quartz Medicare Advantage |
$12,929.28
|
| Rate for Payer: The Alliance Commercial |
$10,774.40
|
| Rate for Payer: WEA Trust Commercial |
$11,851.84
|
| Rate for Payer: WPS Commercial |
$15,960.62
|
|
|
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 |
$10,558.91 |
| Max. Negotiated Rate |
$19,824.90 |
| Rate for Payer: Aetna Commercial |
$19,393.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,531.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,420.86
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cigna Commercial |
$19,824.90
|
| Rate for Payer: Health EOS Commercial |
$19,178.43
|
| Rate for Payer: HFN Commercial |
$19,824.90
|
| Rate for Payer: Multiplan Commercial |
$17,239.04
|
| Rate for Payer: Preferred Network Access Commercial |
$19,824.90
|
| Rate for Payer: Quartz Beloit One Network |
$10,558.91
|
| Rate for Payer: Quartz Commercial |
$12,929.28
|
| Rate for Payer: WEA Trust Commercial |
$11,851.84
|
| Rate for Payer: WPS Commercial |
$15,960.62
|
|
|
Viabahn 6mm x 15cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,472.26 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,149.71
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 6mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,269.87 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,269.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,912.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,624.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,319.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,533.87
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,437.14
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: NAPHCARE Commercial |
$9,149.71
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,912.19
|
| Rate for Payer: Quartz Medicare Advantage |
$9,149.71
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 6mm x 15cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,709.79 |
| Max. Negotiated Rate |
$14,487.04 |
| Rate for Payer: Aetna Commercial |
$14,487.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,487.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,624.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,149.71
|
| Rate for Payer: Health EOS Commercial |
$13,877.06
|
| Rate for Payer: HFN Commercial |
$14,487.04
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,487.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,709.79
|
| Rate for Payer: Quartz Commercial |
$8,692.23
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
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 |
$6,955.89 |
| Max. Negotiated Rate |
$22,855.08 |
| Rate for Payer: Aetna Commercial |
$22,358.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,364.53
|
| Rate for Payer: Aetna Managed Medicare |
$6,955.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,147.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,421.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,924.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,166.51
|
| Rate for Payer: Cash Price |
$7,166.10
|
| Rate for Payer: Cigna Commercial |
$22,855.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,902.23
|
| Rate for Payer: Health EOS Commercial |
$22,109.81
|
| Rate for Payer: HFN Commercial |
$22,855.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,631.86
|
| Rate for Payer: Multiplan Commercial |
$19,873.98
|
| Rate for Payer: NAPHCARE Commercial |
$14,905.49
|
| Rate for Payer: Preferred Network Access Commercial |
$22,855.08
|
| Rate for Payer: Quartz Beloit One Network |
$12,172.82
|
| Rate for Payer: Quartz Commercial |
$16,147.61
|
| Rate for Payer: Quartz Medicare Advantage |
$14,905.49
|
| Rate for Payer: The Alliance Commercial |
$12,421.24
|
| Rate for Payer: WEA Trust Commercial |
$13,663.36
|
| Rate for Payer: WPS Commercial |
$18,400.16
|
|
|
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 |
$12,172.82 |
| Max. Negotiated Rate |
$22,855.08 |
| Rate for Payer: Aetna Commercial |
$22,358.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,364.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,166.51
|
| Rate for Payer: Cash Price |
$7,166.10
|
| Rate for Payer: Cigna Commercial |
$22,855.08
|
| Rate for Payer: Health EOS Commercial |
$22,109.81
|
| Rate for Payer: HFN Commercial |
$22,855.08
|
| Rate for Payer: Multiplan Commercial |
$19,873.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22,855.08
|
| Rate for Payer: Quartz Beloit One Network |
$12,172.82
|
| Rate for Payer: Quartz Commercial |
$14,905.49
|
| Rate for Payer: WEA Trust Commercial |
$13,663.36
|
| Rate for Payer: WPS Commercial |
$18,400.16
|
|
|
Viabahn 6mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,472.26 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,149.71
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 6mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,709.79 |
| Max. Negotiated Rate |
$14,487.04 |
| Rate for Payer: Aetna Commercial |
$14,487.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,487.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,624.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,149.71
|
| Rate for Payer: Health EOS Commercial |
$13,877.06
|
| Rate for Payer: HFN Commercial |
$14,487.04
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: Preferred Network Access Commercial |
$14,487.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,709.79
|
| Rate for Payer: Quartz Commercial |
$8,692.23
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
Viabahn 6mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,269.87 |
| Max. Negotiated Rate |
$14,029.56 |
| Rate for Payer: Aetna Commercial |
$13,724.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,114.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,269.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,912.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,624.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,319.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,082.25
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$14,029.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,533.87
|
| Rate for Payer: Health EOS Commercial |
$13,572.07
|
| Rate for Payer: HFN Commercial |
$14,029.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,437.14
|
| Rate for Payer: Multiplan Commercial |
$12,199.62
|
| Rate for Payer: NAPHCARE Commercial |
$9,149.71
|
| Rate for Payer: Preferred Network Access Commercial |
$14,029.56
|
| Rate for Payer: Quartz Beloit One Network |
$7,472.26
|
| Rate for Payer: Quartz Commercial |
$9,912.19
|
| Rate for Payer: Quartz Medicare Advantage |
$9,149.71
|
| Rate for Payer: The Alliance Commercial |
$7,624.76
|
| Rate for Payer: WEA Trust Commercial |
$8,387.24
|
| Rate for Payer: WPS Commercial |
$11,294.91
|
|
|
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 |
$9,025.02 |
| Max. Negotiated Rate |
$16,944.93 |
| Rate for Payer: Aetna Commercial |
$16,576.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,839.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,761.75
|
| Rate for Payer: Cash Price |
$5,313.00
|
| Rate for Payer: Cigna Commercial |
$16,944.93
|
| Rate for Payer: Health EOS Commercial |
$16,392.38
|
| Rate for Payer: HFN Commercial |
$16,944.93
|
| Rate for Payer: Multiplan Commercial |
$14,734.72
|
| Rate for Payer: Preferred Network Access Commercial |
$16,944.93
|
| Rate for Payer: Quartz Beloit One Network |
$9,025.02
|
| Rate for Payer: Quartz Commercial |
$11,051.04
|
| Rate for Payer: WEA Trust Commercial |
$10,130.12
|
| Rate for Payer: WPS Commercial |
$13,642.01
|
|
