|
BALLOON 2.0x15mm MAVERICK OTW
|
Facility
|
IP
|
$6,401.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,261.95 |
| Max. Negotiated Rate |
$6,124.48 |
| Rate for Payer: Aetna Commercial |
$5,991.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,725.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,528.23
|
| Rate for Payer: Cash Price |
$1,920.30
|
| Rate for Payer: Cigna Commercial |
$6,124.48
|
| Rate for Payer: Health EOS Commercial |
$5,924.77
|
| Rate for Payer: HFN Commercial |
$6,124.48
|
| Rate for Payer: Multiplan Commercial |
$5,325.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.95
|
| Rate for Payer: Quartz Commercial |
$3,994.22
|
| Rate for Payer: WEA Trust Commercial |
$3,661.37
|
| Rate for Payer: WPS Commercial |
$4,930.69
|
|
|
BALLOON 2.0x15mm MAVERICK OTW
|
Facility
|
OP
|
$6,401.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,863.97 |
| Max. Negotiated Rate |
$6,124.48 |
| Rate for Payer: Aetna Commercial |
$5,991.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,725.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,863.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,327.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,328.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,195.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,528.23
|
| Rate for Payer: Cash Price |
$1,920.30
|
| Rate for Payer: Cigna Commercial |
$6,124.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,725.38
|
| Rate for Payer: Health EOS Commercial |
$5,924.77
|
| Rate for Payer: HFN Commercial |
$6,124.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,992.78
|
| Rate for Payer: Multiplan Commercial |
$5,325.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,994.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.95
|
| Rate for Payer: Quartz Commercial |
$4,327.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,994.22
|
| Rate for Payer: The Alliance Commercial |
$3,328.52
|
| Rate for Payer: WEA Trust Commercial |
$3,661.37
|
| Rate for Payer: WPS Commercial |
$4,930.69
|
|
|
BALLOON 2.0x20mm MAVERICK OTW
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,065.79 |
| Max. Negotiated Rate |
$3,501.89 |
| Rate for Payer: Aetna Commercial |
$3,425.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,273.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,065.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,474.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,903.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,827.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,017.39
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$3,501.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,130.12
|
| Rate for Payer: Health EOS Commercial |
$3,387.70
|
| Rate for Payer: HFN Commercial |
$3,501.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,854.80
|
| Rate for Payer: Multiplan Commercial |
$3,045.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,283.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,501.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.14
|
| Rate for Payer: Quartz Commercial |
$2,474.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,283.84
|
| Rate for Payer: The Alliance Commercial |
$1,903.20
|
| Rate for Payer: WEA Trust Commercial |
$2,093.52
|
| Rate for Payer: WPS Commercial |
$2,819.30
|
|
|
BALLOON 2.0x20mm MAVERICK OTW
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,865.14 |
| Max. Negotiated Rate |
$3,501.89 |
| Rate for Payer: Aetna Commercial |
$3,425.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,273.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,017.39
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$3,501.89
|
| Rate for Payer: Health EOS Commercial |
$3,387.70
|
| Rate for Payer: HFN Commercial |
$3,501.89
|
| Rate for Payer: Multiplan Commercial |
$3,045.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,501.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.14
|
| Rate for Payer: Quartz Commercial |
$2,283.84
|
| Rate for Payer: WEA Trust Commercial |
$2,093.52
|
| Rate for Payer: WPS Commercial |
$2,819.30
|
|
|
BALLOON 2.5x15mm MAVERICK OTW
|
Facility
|
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.00 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
BALLOON 2.5x15mm MAVERICK OTW
|
Facility
|
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.71 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Aetna Managed Medicare |
$621.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.57
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.30
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,443.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.24
|
| Rate for Payer: The Alliance Commercial |
$1,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
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 |
$995.03 |
| Max. Negotiated Rate |
$3,269.39 |
| Rate for Payer: Aetna Commercial |
$3,198.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,056.16
|
| Rate for Payer: Aetna Managed Medicare |
$995.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,309.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,776.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,705.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,883.45
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cigna Commercial |
$3,269.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,988.69
|
| Rate for Payer: Health EOS Commercial |
$3,162.78
|
| Rate for Payer: HFN Commercial |
$3,269.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,665.26
|
| Rate for Payer: Multiplan Commercial |
$2,842.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,132.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,269.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,741.30
|
| Rate for Payer: Quartz Commercial |
$2,309.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,132.21
|
| Rate for Payer: The Alliance Commercial |
$1,776.84
|
| Rate for Payer: WEA Trust Commercial |
$1,954.52
|
| Rate for Payer: WPS Commercial |
$2,632.12
|
|
|
BALLOON 2.5 X 80mm
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,741.30 |
| Max. Negotiated Rate |
$3,269.39 |
| Rate for Payer: Aetna Commercial |
$3,198.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,056.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,883.45
|
| Rate for Payer: Cash Price |
$1,025.10
|
| Rate for Payer: Cigna Commercial |
$3,269.39
|
| Rate for Payer: Health EOS Commercial |
$3,162.78
|
| Rate for Payer: HFN Commercial |
$3,269.39
|
| Rate for Payer: Multiplan Commercial |
$2,842.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,269.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,741.30
|
| Rate for Payer: Quartz Commercial |
$2,132.21
|
| Rate for Payer: WEA Trust Commercial |
$1,954.52
|
| Rate for Payer: WPS Commercial |
$2,632.12
|
|
|
BALLOON 2.5 X 8mm APEX
|
Facility
|
OP
|
$2,288.00
|
|
| Hospital Charge Code |
2972958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.62
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$1,189.76
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
BALLOON 2.5 X 8mm APEX
|
Facility
|
IP
|
$2,288.00
|
|
| Hospital Charge Code |
2972958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
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 |
$994.45 |
| Max. Negotiated Rate |
$3,267.47 |
| Rate for Payer: Aetna Commercial |
$3,196.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.38
|
| Rate for Payer: Aetna Managed Medicare |
$994.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,308.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,775.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.35
|
| Rate for Payer: Cash Price |
$1,024.50
|
| Rate for Payer: Cigna Commercial |
$3,267.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,987.53
|
| Rate for Payer: Health EOS Commercial |
$3,160.92
|
| Rate for Payer: HFN Commercial |
$3,267.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,663.70
|
| Rate for Payer: Multiplan Commercial |
$2,841.28
|
| Rate for Payer: NAPHCARE Commercial |
$2,130.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.28
|
| Rate for Payer: Quartz Commercial |
$2,308.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,130.96
|
| Rate for Payer: The Alliance Commercial |
$1,775.80
|
| Rate for Payer: WEA Trust Commercial |
$1,953.38
|
| Rate for Payer: WPS Commercial |
$2,630.57
|
|
|
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 |
$1,740.28 |
| Max. Negotiated Rate |
$3,267.47 |
| Rate for Payer: Aetna Commercial |
$3,196.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.35
|
| Rate for Payer: Cash Price |
$1,024.50
|
| Rate for Payer: Cigna Commercial |
$3,267.47
|
| Rate for Payer: Health EOS Commercial |
$3,160.92
|
| Rate for Payer: HFN Commercial |
$3,267.47
|
| Rate for Payer: Multiplan Commercial |
$2,841.28
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.28
|
| Rate for Payer: Quartz Commercial |
$2,130.96
|
| Rate for Payer: WEA Trust Commercial |
$1,953.38
|
| Rate for Payer: WPS Commercial |
$2,630.57
|
|
|
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 |
$1,088.00 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
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 |
$621.71 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Aetna Managed Medicare |
$621.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.57
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.30
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,443.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.24
|
| Rate for Payer: The Alliance Commercial |
$1,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
BALLOON 3 X100mm AB35W03100135
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.97 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Aetna Managed Medicare |
$665.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.03
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.86
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,546.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.09
|
| Rate for Payer: The Alliance Commercial |
$1,189.24
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
BALLOON 3 X100mm AB35W03100135
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.46 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,427.09
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
BALLOON 3X 120mm AB35W03120135
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 3X 120mm AB35W03120135
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
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 |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
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 |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
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 |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
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 |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
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 |
$621.71 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Aetna Managed Medicare |
$621.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.57
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.30
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,443.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.24
|
| Rate for Payer: The Alliance Commercial |
$1,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
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 |
$1,088.00 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
BALLOON 4.0x80mm AB35W04080135
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
