|
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 |
$5,157.15 |
| 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: Aetna Managed Medicare |
$5,157.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,971.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,209.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,840.83
|
| 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: Dean Health DHI/DHP/ASO |
$10,307.22
|
| Rate for Payer: Health EOS Commercial |
$16,392.38
|
| Rate for Payer: HFN Commercial |
$16,944.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,813.80
|
| Rate for Payer: Multiplan Commercial |
$14,734.72
|
| Rate for Payer: NAPHCARE Commercial |
$11,051.04
|
| 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 |
$11,971.96
|
| Rate for Payer: Quartz Medicare Advantage |
$11,051.04
|
| Rate for Payer: The Alliance Commercial |
$9,209.20
|
| Rate for Payer: WEA Trust Commercial |
$10,130.12
|
| Rate for Payer: WPS Commercial |
$13,642.01
|
|
|
Viabahn 7mm x 10cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,709.79 |
| 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 7mm x 10cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549080
|
|
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 7mm x 10cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549080
|
|
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 7mm X 10cm VBHR071002A
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,312.94 |
| Max. Negotiated Rate |
$17,485.52 |
| Rate for Payer: Aetna Commercial |
$17,105.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,345.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,073.18
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$17,485.52
|
| Rate for Payer: Health EOS Commercial |
$16,915.34
|
| Rate for Payer: HFN Commercial |
$17,485.52
|
| Rate for Payer: Multiplan Commercial |
$15,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,485.52
|
| Rate for Payer: Quartz Beloit One Network |
$9,312.94
|
| Rate for Payer: Quartz Commercial |
$11,403.60
|
| Rate for Payer: WEA Trust Commercial |
$10,453.30
|
| Rate for Payer: WPS Commercial |
$14,077.23
|
|
|
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 |
$5,321.68 |
| Max. Negotiated Rate |
$17,485.52 |
| Rate for Payer: Aetna Commercial |
$17,105.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,345.16
|
| Rate for Payer: Aetna Managed Medicare |
$5,321.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,353.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,073.18
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$17,485.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,636.05
|
| Rate for Payer: Health EOS Commercial |
$16,915.34
|
| Rate for Payer: HFN Commercial |
$17,485.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,254.50
|
| Rate for Payer: Multiplan Commercial |
$15,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,403.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,485.52
|
| Rate for Payer: Quartz Beloit One Network |
$9,312.94
|
| Rate for Payer: Quartz Commercial |
$12,353.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11,403.60
|
| Rate for Payer: The Alliance Commercial |
$9,503.00
|
| Rate for Payer: WEA Trust Commercial |
$10,453.30
|
| Rate for Payer: WPS Commercial |
$14,077.23
|
|
|
Viabahn 7mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,269.87 |
| 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 7mm x 15cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549082
|
|
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 7mm x 15cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549082
|
|
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 7mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549078
|
|
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 7mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549078
|
|
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 7mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549078
|
|
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 7mm X 5CM #VBH070502
|
Facility
|
IP
|
$15,652.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,976.26 |
| Max. Negotiated Rate |
$14,975.83 |
| Rate for Payer: Aetna Commercial |
$14,650.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,999.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,627.38
|
| Rate for Payer: Cash Price |
$4,695.60
|
| Rate for Payer: Cigna Commercial |
$14,975.83
|
| Rate for Payer: Health EOS Commercial |
$14,487.49
|
| Rate for Payer: HFN Commercial |
$14,975.83
|
| Rate for Payer: Multiplan Commercial |
$13,022.46
|
| Rate for Payer: Preferred Network Access Commercial |
$14,975.83
|
| Rate for Payer: Quartz Beloit One Network |
$7,976.26
|
| Rate for Payer: Quartz Commercial |
$9,766.85
|
| Rate for Payer: WEA Trust Commercial |
$8,952.94
|
| Rate for Payer: WPS Commercial |
$12,056.74
|
|
|
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 |
$4,557.86 |
| Max. Negotiated Rate |
$14,975.83 |
| Rate for Payer: Aetna Commercial |
$14,650.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,999.15
|
| Rate for Payer: Aetna Managed Medicare |
$4,557.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,580.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,139.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,813.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,627.38
|
| Rate for Payer: Cash Price |
$4,695.60
|
| Rate for Payer: Cigna Commercial |
$14,975.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,109.46
|
| Rate for Payer: Health EOS Commercial |
$14,487.49
|
| Rate for Payer: HFN Commercial |
$14,975.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,208.56
|
| Rate for Payer: Multiplan Commercial |
$13,022.46
|
| Rate for Payer: NAPHCARE Commercial |
$9,766.85
|
| Rate for Payer: Preferred Network Access Commercial |
$14,975.83
|
| Rate for Payer: Quartz Beloit One Network |
$7,976.26
|
| Rate for Payer: Quartz Commercial |
$10,580.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,766.85
|
| Rate for Payer: The Alliance Commercial |
$8,139.04
|
| Rate for Payer: WEA Trust Commercial |
$8,952.94
|
| Rate for Payer: WPS Commercial |
$12,056.74
|
|
|
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 |
$6,325.16 |
| Max. Negotiated Rate |
$20,782.65 |
| Rate for Payer: Aetna Commercial |
$20,330.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,427.26
|
| Rate for Payer: Aetna Managed Medicare |
$6,325.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,683.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,294.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,843.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,972.62
|
| Rate for Payer: Cash Price |
$6,516.30
|
| Rate for Payer: Cigna Commercial |
$20,782.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,641.62
|
| Rate for Payer: Health EOS Commercial |
$20,104.96
|
| Rate for Payer: HFN Commercial |
$20,782.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,942.38
|
| Rate for Payer: Multiplan Commercial |
$18,071.87
|
| Rate for Payer: NAPHCARE Commercial |
$13,553.90
|
| Rate for Payer: Preferred Network Access Commercial |
$20,782.65
|
| Rate for Payer: Quartz Beloit One Network |
$11,069.02
|
| Rate for Payer: Quartz Commercial |
$14,683.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13,553.90
|
| Rate for Payer: The Alliance Commercial |
$11,294.92
|
| Rate for Payer: WEA Trust Commercial |
$12,424.41
|
| Rate for Payer: WPS Commercial |
$16,731.69
|
|
|
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 |
$11,069.02 |
| Max. Negotiated Rate |
$20,782.65 |
| Rate for Payer: Aetna Commercial |
$20,330.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,427.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,972.62
|
| Rate for Payer: Cash Price |
$6,516.30
|
| Rate for Payer: Cigna Commercial |
$20,782.65
|
| Rate for Payer: Health EOS Commercial |
$20,104.96
|
| Rate for Payer: HFN Commercial |
$20,782.65
|
| Rate for Payer: Multiplan Commercial |
$18,071.87
|
| Rate for Payer: Preferred Network Access Commercial |
$20,782.65
|
| Rate for Payer: Quartz Beloit One Network |
$11,069.02
|
| Rate for Payer: Quartz Commercial |
$13,553.90
|
| Rate for Payer: WEA Trust Commercial |
$12,424.41
|
| Rate for Payer: WPS Commercial |
$16,731.69
|
|
|
Viance CTO Catheter
|
Facility
|
OP
|
$11,539.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,360.16 |
| Max. Negotiated Rate |
$11,040.52 |
| Rate for Payer: Aetna Commercial |
$10,800.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,320.48
|
| Rate for Payer: Aetna Managed Medicare |
$3,360.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,800.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,000.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,760.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,360.30
|
| Rate for Payer: Cash Price |
$3,461.70
|
| Rate for Payer: Cigna Commercial |
$11,040.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,715.70
|
| Rate for Payer: Health EOS Commercial |
$10,680.50
|
| Rate for Payer: HFN Commercial |
$11,040.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,000.42
|
| Rate for Payer: Multiplan Commercial |
$9,600.45
|
| Rate for Payer: NAPHCARE Commercial |
$7,200.34
|
| Rate for Payer: Preferred Network Access Commercial |
$11,040.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,880.27
|
| Rate for Payer: Quartz Commercial |
$7,800.36
|
| Rate for Payer: Quartz Medicare Advantage |
$7,200.34
|
| Rate for Payer: The Alliance Commercial |
$6,000.28
|
| Rate for Payer: WEA Trust Commercial |
$6,600.31
|
| Rate for Payer: WPS Commercial |
$8,888.49
|
|
|
Viance CTO Catheter
|
Facility
|
IP
|
$11,539.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4528616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,880.27 |
| Max. Negotiated Rate |
$11,040.52 |
| Rate for Payer: Aetna Commercial |
$10,800.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,320.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,360.30
|
| Rate for Payer: Cash Price |
$3,461.70
|
| Rate for Payer: Cigna Commercial |
$11,040.52
|
| Rate for Payer: Health EOS Commercial |
$10,680.50
|
| Rate for Payer: HFN Commercial |
$11,040.52
|
| Rate for Payer: Multiplan Commercial |
$9,600.45
|
| Rate for Payer: Preferred Network Access Commercial |
$11,040.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,880.27
|
| Rate for Payer: Quartz Commercial |
$7,200.34
|
| Rate for Payer: WEA Trust Commercial |
$6,600.31
|
| Rate for Payer: WPS Commercial |
$8,888.49
|
|
|
Vibration
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989708
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Vibration
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989708
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
VIDEO PRINT FEE
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2962810
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
VIDEO PRINT FEE
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2962810
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
Viperwire Fex .014
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5184613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.01 |
| Max. Negotiated Rate |
$2,369.04 |
| Rate for Payer: Aetna Commercial |
$2,317.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,214.53
|
| Rate for Payer: Aetna Managed Medicare |
$721.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,673.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,287.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.77
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,369.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,441.03
|
| Rate for Payer: Health EOS Commercial |
$2,291.79
|
| Rate for Payer: HFN Commercial |
$2,369.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,931.28
|
| Rate for Payer: Multiplan Commercial |
$2,060.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,545.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.77
|
| Rate for Payer: Quartz Commercial |
$1,673.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,545.02
|
| Rate for Payer: The Alliance Commercial |
$1,287.52
|
| Rate for Payer: WEA Trust Commercial |
$1,416.27
|
| Rate for Payer: WPS Commercial |
$1,907.26
|
|
|
Viperwire Fex .014
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5184613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.77 |
| Max. Negotiated Rate |
$2,369.04 |
| Rate for Payer: Aetna Commercial |
$2,317.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,214.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.77
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,369.04
|
| Rate for Payer: Health EOS Commercial |
$2,291.79
|
| Rate for Payer: HFN Commercial |
$2,369.04
|
| Rate for Payer: Multiplan Commercial |
$2,060.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.77
|
| Rate for Payer: Quartz Commercial |
$1,545.02
|
| Rate for Payer: WEA Trust Commercial |
$1,416.27
|
| Rate for Payer: WPS Commercial |
$1,907.26
|
|
|
Viral Culture, Non Respiratory Body Fluids
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
983433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$406.07 |
| Rate for Payer: Aetna Commercial |
$406.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.60
|
| Rate for Payer: Aetna Managed Medicare |
$27.11
|
| Rate for Payer: Anthem Medicare Advantage |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.11
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$406.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.11
|
| Rate for Payer: Health EOS Commercial |
$388.97
|
| Rate for Payer: HFN Commercial |
$406.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$341.95
|
| Rate for Payer: NAPHCARE Commercial |
$40.67
|
| Rate for Payer: Preferred Network Access Commercial |
$406.07
|
| Rate for Payer: Quartz Beloit One Network |
$188.07
|
| Rate for Payer: Quartz Commercial |
$243.64
|
| Rate for Payer: Quartz Medicare Advantage |
$27.11
|
| Rate for Payer: The Alliance Commercial |
$107.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: WEA Trust Commercial |
$235.09
|
| Rate for Payer: WPS Commercial |
$119.30
|
|
