|
BALLOON 2.5 X 80mm
|
Facility
OP
|
$3,417.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$956.76 |
| Max. Negotiated Rate |
$3,143.64 |
| Rate for Payer: Aetna Commercial |
$3,075.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,938.62
|
| Rate for Payer: Aetna Managed Medicare |
$956.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,221.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,708.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,640.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.01
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cigna Commercial |
$3,143.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,912.15
|
| Rate for Payer: Health EOS Commercial |
$3,041.13
|
| Rate for Payer: HFN Commercial |
$3,143.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,562.75
|
| Rate for Payer: Multiplan Commercial |
$2,733.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,050.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,143.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,674.33
|
| Rate for Payer: Quartz Commercial |
$2,221.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,050.20
|
| Rate for Payer: WEA Trust Commercial |
$1,879.35
|
| Rate for Payer: WPS Commercial |
$2,530.97
|
|
|
BALLOON 2.5 X 8mm APEX
|
Facility
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.64 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.36
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
BALLOON 2.5 X 8mm APEX
|
Facility
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
BALLOON 3.0 X 120 PTA
|
Facility
IP
|
$3,415.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,673.35 |
| Max. Negotiated Rate |
$3,141.80 |
| Rate for Payer: Aetna Commercial |
$3,073.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.95
|
| Rate for Payer: Cash Price |
$1,024.50
|
| Rate for Payer: Cigna Commercial |
$3,141.80
|
| Rate for Payer: Health EOS Commercial |
$3,039.35
|
| Rate for Payer: HFN Commercial |
$3,141.80
|
| Rate for Payer: Multiplan Commercial |
$2,732.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,049.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.35
|
| Rate for Payer: Quartz Commercial |
$2,049.00
|
| Rate for Payer: WEA Trust Commercial |
$1,878.25
|
| Rate for Payer: WPS Commercial |
$2,529.49
|
|
|
BALLOON 3.0 X 120 PTA
|
Facility
OP
|
$3,415.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$956.20 |
| Max. Negotiated Rate |
$3,141.80 |
| Rate for Payer: Aetna Commercial |
$3,073.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.90
|
| Rate for Payer: Aetna Managed Medicare |
$956.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,639.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.95
|
| Rate for Payer: Cash Price |
$1,024.50
|
| Rate for Payer: Cigna Commercial |
$3,141.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,911.03
|
| Rate for Payer: Health EOS Commercial |
$3,039.35
|
| Rate for Payer: HFN Commercial |
$3,141.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,561.25
|
| Rate for Payer: Multiplan Commercial |
$2,732.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,049.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.35
|
| Rate for Payer: Quartz Commercial |
$2,219.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,049.00
|
| Rate for Payer: WEA Trust Commercial |
$1,878.25
|
| Rate for Payer: WPS Commercial |
$2,529.49
|
|
|
BALLOON 3.0x15mm MAVERICK OTW
|
Facility
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$1,964.20 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.10
|
| Rate for Payer: Aetna Managed Medicare |
$597.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,387.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,067.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,024.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,194.75
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,601.25
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,387.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,281.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
BALLOON 3.0x15mm MAVERICK OTW
|
Facility
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,046.15 |
| Max. Negotiated Rate |
$1,964.20 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,281.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
BALLOON 3 X100mm AB35W03100135
|
Facility
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.36 |
| Max. Negotiated Rate |
$2,104.04 |
| Rate for Payer: Aetna Commercial |
$2,058.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| Rate for Payer: Aetna Managed Medicare |
$640.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,486.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,143.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.11
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,104.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.81
|
| Rate for Payer: Health EOS Commercial |
$2,035.43
|
| Rate for Payer: HFN Commercial |
$2,104.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,715.25
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.63
|
| Rate for Payer: Quartz Commercial |
$1,486.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.20
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
BALLOON 3 X100mm AB35W03100135
|
Facility
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.63 |
| Max. Negotiated Rate |
$2,104.04 |
| Rate for Payer: Aetna Commercial |
$2,058.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.11
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,104.04
|
| Rate for Payer: Health EOS Commercial |
$2,035.43
|
| Rate for Payer: HFN Commercial |
$2,104.04
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.63
|
| Rate for Payer: Quartz Commercial |
$1,372.20
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
BALLOON 3X 120mm AB35W03120135
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 3X 120mm AB35W03120135
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 3 x 40mm AB35W03040135
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 3 x 40mm AB35W03040135
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 3 X 80mm AB35W03080135
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 3 X 80mm AB35W03080135
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4.0x15mm MAVERICK OTW
|
Facility
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,046.15 |
| Max. Negotiated Rate |
$1,964.20 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,281.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
BALLOON 4.0x15mm MAVERICK OTW
|
Facility
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$1,964.20 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.10
|
| Rate for Payer: Aetna Managed Medicare |
$597.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,387.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,067.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,024.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,194.75
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,601.25
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,387.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,281.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
BALLOON 4.0x80mm AB35W04080135
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4.0x80mm AB35W04080135
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4mmX20mm AB35W04020080
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4mmX20mm AB35W04020080
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4X 100mm AB35W04100135
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4X 100mm AB35W04100135
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
BALLOON 4x10 HURRICANE DILATOR 4596
|
Facility
OP
|
$2,794.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$782.32 |
| Max. Negotiated Rate |
$2,570.48 |
| Rate for Payer: Aetna Commercial |
$2,514.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,402.84
|
| Rate for Payer: Aetna Managed Medicare |
$782.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,816.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,397.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,341.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.82
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$2,570.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,563.52
|
| Rate for Payer: Health EOS Commercial |
$2,486.66
|
| Rate for Payer: HFN Commercial |
$2,570.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,095.50
|
| Rate for Payer: Multiplan Commercial |
$2,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.06
|
| Rate for Payer: Quartz Commercial |
$1,816.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,676.40
|
| Rate for Payer: WEA Trust Commercial |
$1,536.70
|
| Rate for Payer: WPS Commercial |
$2,069.52
|
|
|
BALLOON 4x10 HURRICANE DILATOR 4596
|
Facility
IP
|
$2,794.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,369.06 |
| Max. Negotiated Rate |
$2,570.48 |
| Rate for Payer: Aetna Commercial |
$2,514.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.82
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$2,570.48
|
| Rate for Payer: Health EOS Commercial |
$2,486.66
|
| Rate for Payer: HFN Commercial |
$2,570.48
|
| Rate for Payer: Multiplan Commercial |
$2,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.06
|
| Rate for Payer: Quartz Commercial |
$1,676.40
|
| Rate for Payer: WEA Trust Commercial |
$1,536.70
|
| Rate for Payer: WPS Commercial |
$2,069.52
|
|
