|
Viabahn 6mm x 15cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 6mm x 15cm #VBJ061502
|
Facility
|
IP
|
$23,887.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,704.63 |
| Max. Negotiated Rate |
$21,976.04 |
| Rate for Payer: Aetna Commercial |
$21,498.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,542.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,660.11
|
| Rate for Payer: Cash Price |
$7,166.10
|
| Rate for Payer: Cigna Commercial |
$21,976.04
|
| Rate for Payer: Health EOS Commercial |
$21,259.43
|
| Rate for Payer: HFN Commercial |
$21,976.04
|
| Rate for Payer: Multiplan Commercial |
$19,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,332.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,976.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,704.63
|
| Rate for Payer: Quartz Commercial |
$14,332.20
|
| Rate for Payer: WEA Trust Commercial |
$13,137.85
|
| Rate for Payer: WPS Commercial |
$17,693.10
|
|
|
VIABAHN 6mm x 15cm #VBJ061502
|
Facility
|
OP
|
$23,887.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,688.36 |
| Max. Negotiated Rate |
$95,548.00 |
| Rate for Payer: Aetna Commercial |
$21,498.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,542.82
|
| Rate for Payer: Aetna Managed Medicare |
$6,688.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,526.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,943.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,465.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,660.11
|
| Rate for Payer: Cash Price |
$7,166.10
|
| Rate for Payer: Cigna Commercial |
$21,976.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,367.17
|
| Rate for Payer: Health EOS Commercial |
$21,259.43
|
| Rate for Payer: HFN Commercial |
$21,976.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,915.25
|
| Rate for Payer: Multiplan Commercial |
$19,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,332.20
|
| Rate for Payer: Preferred Network Access Commercial |
$21,976.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,704.63
|
| Rate for Payer: Quartz Commercial |
$15,526.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14,332.20
|
| Rate for Payer: The Alliance Commercial |
$95,548.00
|
| Rate for Payer: WEA Trust Commercial |
$13,137.85
|
| Rate for Payer: WPS Commercial |
$17,693.10
|
|
|
Viabahn 6mm x 5cm
|
Professional
|
Both
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.72 |
| Max. Negotiated Rate |
$13,929.85 |
| Rate for Payer: Aetna Commercial |
$13,929.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,929.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,331.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,797.80
|
| Rate for Payer: Health EOS Commercial |
$13,343.33
|
| Rate for Payer: HFN Commercial |
$13,929.85
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,929.85
|
| Rate for Payer: Quartz Beloit One Network |
$6,451.72
|
| Rate for Payer: Quartz Commercial |
$8,357.91
|
| Rate for Payer: The Alliance Commercial |
$7,331.50
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 5cm
|
Facility
|
OP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.64 |
| Max. Negotiated Rate |
$58,652.00 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,105.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,530.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,205.41
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,997.25
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$9,530.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,797.80
|
| Rate for Payer: The Alliance Commercial |
$58,652.00
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
Viabahn 6mm x 5cm
|
Facility
|
IP
|
$14,663.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2549072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,184.87 |
| Max. Negotiated Rate |
$13,489.96 |
| Rate for Payer: Aetna Commercial |
$13,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,771.39
|
| Rate for Payer: Cash Price |
$4,398.90
|
| Rate for Payer: Cigna Commercial |
$13,489.96
|
| Rate for Payer: Health EOS Commercial |
$13,050.07
|
| Rate for Payer: HFN Commercial |
$13,489.96
|
| Rate for Payer: Multiplan Commercial |
$11,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$13,489.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,184.87
|
| Rate for Payer: Quartz Commercial |
$8,797.80
|
| Rate for Payer: WEA Trust Commercial |
$8,064.65
|
| Rate for Payer: WPS Commercial |
$10,860.88
|
|
|
VIABAHN 6mm X 5cm #VBJ060502
|
Facility
|
OP
|
$17,710.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,958.80 |
| Max. Negotiated Rate |
$70,840.00 |
| Rate for Payer: Aetna Commercial |
$15,939.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,230.60
|
| Rate for Payer: Aetna Managed Medicare |
$4,958.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,511.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,855.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,500.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,386.30
|
| Rate for Payer: Cash Price |
$5,313.00
|
| Rate for Payer: Cigna Commercial |
$16,293.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,910.52
|
| Rate for Payer: Health EOS Commercial |
$15,761.90
|
| Rate for Payer: HFN Commercial |
$16,293.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,282.50
|
| Rate for Payer: Multiplan Commercial |
$14,168.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,626.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,293.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,677.90
|
| Rate for Payer: Quartz Commercial |
$11,511.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10,626.00
|
| Rate for Payer: The Alliance Commercial |
$70,840.00
|
| Rate for Payer: WEA Trust Commercial |
$9,740.50
|
| Rate for Payer: WPS Commercial |
$13,117.80
|
|
|
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
|
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
|
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
|
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 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
|
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 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 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
|
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
|
|
|
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
|
|
|
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
|
|
