|
Balloon-Coronary Cutting
|
Facility
|
OP
|
$6,647.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,861.16 |
| Max. Negotiated Rate |
$26,588.00 |
| Rate for Payer: Aetna Commercial |
$5,982.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,716.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,861.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,320.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,190.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,522.91
|
| Rate for Payer: Cash Price |
$1,994.10
|
| Rate for Payer: Cigna Commercial |
$6,115.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,719.66
|
| Rate for Payer: Health EOS Commercial |
$5,915.83
|
| Rate for Payer: HFN Commercial |
$6,115.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,985.25
|
| Rate for Payer: Multiplan Commercial |
$5,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,115.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,257.03
|
| Rate for Payer: Quartz Commercial |
$4,320.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,988.20
|
| Rate for Payer: The Alliance Commercial |
$26,588.00
|
| Rate for Payer: WEA Trust Commercial |
$3,655.85
|
| Rate for Payer: WPS Commercial |
$4,923.43
|
|
|
Balloon-Coronary Cutting
|
Facility
|
IP
|
$6,647.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,257.03 |
| Max. Negotiated Rate |
$6,115.24 |
| Rate for Payer: Aetna Commercial |
$5,982.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,716.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,522.91
|
| Rate for Payer: Cash Price |
$1,994.10
|
| Rate for Payer: Cigna Commercial |
$6,115.24
|
| Rate for Payer: Health EOS Commercial |
$5,915.83
|
| Rate for Payer: HFN Commercial |
$6,115.24
|
| Rate for Payer: Multiplan Commercial |
$5,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,115.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,257.03
|
| Rate for Payer: Quartz Commercial |
$3,988.20
|
| Rate for Payer: WEA Trust Commercial |
$3,655.85
|
| Rate for Payer: WPS Commercial |
$4,923.43
|
|
|
Balloon-Coronary RX/OTW/NC
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.52 |
| Max. Negotiated Rate |
$6,336.00 |
| Rate for Payer: Aetna Commercial |
$1,425.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,362.24
|
| Rate for Payer: Aetna Managed Medicare |
$443.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,029.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$839.52
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$1,457.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.41
|
| Rate for Payer: Health EOS Commercial |
$1,409.76
|
| Rate for Payer: HFN Commercial |
$1,457.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$950.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,457.28
|
| Rate for Payer: Quartz Beloit One Network |
$776.16
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: Quartz Medicare Advantage |
$950.40
|
| Rate for Payer: The Alliance Commercial |
$6,336.00
|
| Rate for Payer: WEA Trust Commercial |
$871.20
|
| Rate for Payer: WPS Commercial |
$1,173.27
|
|
|
Balloon-Coronary RX/OTW/NC
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.16 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,425.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,362.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$839.52
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$1,457.28
|
| Rate for Payer: Health EOS Commercial |
$1,409.76
|
| Rate for Payer: HFN Commercial |
$1,457.28
|
| Rate for Payer: Multiplan Commercial |
$1,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$950.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,457.28
|
| Rate for Payer: Quartz Beloit One Network |
$776.16
|
| Rate for Payer: Quartz Commercial |
$950.40
|
| Rate for Payer: WEA Trust Commercial |
$871.20
|
| Rate for Payer: WPS Commercial |
$1,173.27
|
|
|
BALLOON DILATATION CATHETER UROMAX ULTRA 18FR X 10CM M0062251170
|
Facility
|
OP
|
$2,955.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5306816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$11,820.00 |
| Rate for Payer: Aetna Commercial |
$2,659.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Aetna Managed Medicare |
$827.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,418.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.15
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,718.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.62
|
| Rate for Payer: Health EOS Commercial |
$2,629.95
|
| Rate for Payer: HFN Commercial |
$2,718.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,216.25
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,718.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.95
|
| Rate for Payer: Quartz Commercial |
$1,920.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,773.00
|
| Rate for Payer: The Alliance Commercial |
$11,820.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
BALLOON DILATATION CATHETER UROMAX ULTRA 18FR X 10CM M0062251170
|
Facility
|
IP
|
$2,955.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5306816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.95 |
| Max. Negotiated Rate |
$2,718.60 |
| Rate for Payer: Aetna Commercial |
$2,659.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.15
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,718.60
|
| Rate for Payer: Health EOS Commercial |
$2,629.95
|
| Rate for Payer: HFN Commercial |
$2,718.60
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,718.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.95
|
| Rate for Payer: Quartz Commercial |
$1,773.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
BALLOON DILATION
|
Facility
|
OP
|
$1,086.00
|
|
| Hospital Charge Code |
2960550
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Aetna Managed Medicare |
$304.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$543.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.73
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.50
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$705.90
|
| Rate for Payer: Quartz Medicare Advantage |
$651.60
|
| Rate for Payer: The Alliance Commercial |
$4,344.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BALLOON DILATION
|
Facility
|
IP
|
$1,086.00
|
|
| Hospital Charge Code |
2960550
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$532.14 |
| Max. Negotiated Rate |
$999.12 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$651.60
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BALLOON DILATION CATHETER MUSTANG 6.0 x 20x 75cm H74939171060270
|
Facility
|
IP
|
$3,842.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,882.58 |
| Max. Negotiated Rate |
$3,534.64 |
| Rate for Payer: Aetna Commercial |
$3,457.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.26
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cigna Commercial |
$3,534.64
|
| Rate for Payer: Health EOS Commercial |
$3,419.38
|
| Rate for Payer: HFN Commercial |
$3,534.64
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,534.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,882.58
|
| Rate for Payer: Quartz Commercial |
$2,305.20
|
| Rate for Payer: WEA Trust Commercial |
$2,113.10
|
| Rate for Payer: WPS Commercial |
$2,845.77
|
|
|
BALLOON DILATION CATHETER MUSTANG 6.0 x 20x 75cm H74939171060270
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.76 |
| Max. Negotiated Rate |
$15,368.00 |
| Rate for Payer: Aetna Commercial |
$3,457.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,075.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,497.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,921.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,844.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.26
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cigna Commercial |
$3,534.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,149.98
|
| Rate for Payer: Health EOS Commercial |
$3,419.38
|
| Rate for Payer: HFN Commercial |
$3,534.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,881.50
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,534.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,882.58
|
| Rate for Payer: Quartz Commercial |
$2,497.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,305.20
|
| Rate for Payer: The Alliance Commercial |
$15,368.00
|
| Rate for Payer: WEA Trust Commercial |
$2,113.10
|
| Rate for Payer: WPS Commercial |
$2,845.77
|
|
|
BALLOON DILATION CATHETER UROMAX ULTRA 15FR X 10CM M0062251160
|
Facility
|
OP
|
$2,955.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5306815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$11,820.00 |
| Rate for Payer: Aetna Commercial |
$2,659.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Aetna Managed Medicare |
$827.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,418.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.15
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,718.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.62
|
| Rate for Payer: Health EOS Commercial |
$2,629.95
|
| Rate for Payer: HFN Commercial |
$2,718.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,216.25
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,718.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.95
|
| Rate for Payer: Quartz Commercial |
$1,920.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,773.00
|
| Rate for Payer: The Alliance Commercial |
$11,820.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
BALLOON DILATION CATHETER UROMAX ULTRA 15FR X 10CM M0062251160
|
Facility
|
IP
|
$2,955.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5306815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.95 |
| Max. Negotiated Rate |
$2,718.60 |
| Rate for Payer: Aetna Commercial |
$2,659.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.15
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,718.60
|
| Rate for Payer: Health EOS Commercial |
$2,629.95
|
| Rate for Payer: HFN Commercial |
$2,718.60
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,718.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.95
|
| Rate for Payer: Quartz Commercial |
$1,773.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
BALLOON DILATION CRE 3CM 10-12MM M00558930
|
Facility
|
OP
|
$3,265.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496945
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.20 |
| Max. Negotiated Rate |
$13,060.00 |
| Rate for Payer: Aetna Commercial |
$2,938.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.90
|
| Rate for Payer: Aetna Managed Medicare |
$914.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,122.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,567.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.45
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,003.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,827.09
|
| Rate for Payer: Health EOS Commercial |
$2,905.85
|
| Rate for Payer: HFN Commercial |
$3,003.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.75
|
| Rate for Payer: Multiplan Commercial |
$2,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.85
|
| Rate for Payer: Quartz Commercial |
$2,122.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,959.00
|
| Rate for Payer: The Alliance Commercial |
$13,060.00
|
| Rate for Payer: WEA Trust Commercial |
$1,795.75
|
| Rate for Payer: WPS Commercial |
$2,418.39
|
|
|
BALLOON DILATION CRE 3CM 10-12MM M00558930
|
Facility
|
IP
|
$3,265.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496945
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.85 |
| Max. Negotiated Rate |
$3,003.80 |
| Rate for Payer: Aetna Commercial |
$2,938.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.45
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,003.80
|
| Rate for Payer: Health EOS Commercial |
$2,905.85
|
| Rate for Payer: HFN Commercial |
$3,003.80
|
| Rate for Payer: Multiplan Commercial |
$2,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.85
|
| Rate for Payer: Quartz Commercial |
$1,959.00
|
| Rate for Payer: WEA Trust Commercial |
$1,795.75
|
| Rate for Payer: WPS Commercial |
$2,418.39
|
|
|
BALLOON DILATION CRE 3CM 12-15MM M00558940
|
Facility
|
IP
|
$3,265.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.85 |
| Max. Negotiated Rate |
$3,003.80 |
| Rate for Payer: Aetna Commercial |
$2,938.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.45
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,003.80
|
| Rate for Payer: Health EOS Commercial |
$2,905.85
|
| Rate for Payer: HFN Commercial |
$3,003.80
|
| Rate for Payer: Multiplan Commercial |
$2,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.85
|
| Rate for Payer: Quartz Commercial |
$1,959.00
|
| Rate for Payer: WEA Trust Commercial |
$1,795.75
|
| Rate for Payer: WPS Commercial |
$2,418.39
|
|
|
BALLOON DILATION CRE 3CM 12-15MM M00558940
|
Facility
|
OP
|
$3,265.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.20 |
| Max. Negotiated Rate |
$13,060.00 |
| Rate for Payer: Aetna Commercial |
$2,938.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.90
|
| Rate for Payer: Aetna Managed Medicare |
$914.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,122.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,567.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.45
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,003.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,827.09
|
| Rate for Payer: Health EOS Commercial |
$2,905.85
|
| Rate for Payer: HFN Commercial |
$3,003.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.75
|
| Rate for Payer: Multiplan Commercial |
$2,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.85
|
| Rate for Payer: Quartz Commercial |
$2,122.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,959.00
|
| Rate for Payer: The Alliance Commercial |
$13,060.00
|
| Rate for Payer: WEA Trust Commercial |
$1,795.75
|
| Rate for Payer: WPS Commercial |
$2,418.39
|
|
|
BALLOON DILATION CRE 3CM 8-10MM M00558920
|
Facility
|
IP
|
$3,270.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,602.30 |
| Max. Negotiated Rate |
$3,008.40 |
| Rate for Payer: Aetna Commercial |
$2,943.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,812.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,733.10
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna Commercial |
$3,008.40
|
| Rate for Payer: Health EOS Commercial |
$2,910.30
|
| Rate for Payer: HFN Commercial |
$3,008.40
|
| Rate for Payer: Multiplan Commercial |
$2,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,962.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,008.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,602.30
|
| Rate for Payer: Quartz Commercial |
$1,962.00
|
| Rate for Payer: WEA Trust Commercial |
$1,798.50
|
| Rate for Payer: WPS Commercial |
$2,422.09
|
|
|
BALLOON DILATION CRE 3CM 8-10MM M00558920
|
Facility
|
OP
|
$3,270.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.60 |
| Max. Negotiated Rate |
$13,080.00 |
| Rate for Payer: Aetna Commercial |
$2,943.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,812.20
|
| Rate for Payer: Aetna Managed Medicare |
$915.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,125.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,569.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,733.10
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna Commercial |
$3,008.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,829.89
|
| Rate for Payer: Health EOS Commercial |
$2,910.30
|
| Rate for Payer: HFN Commercial |
$3,008.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,452.50
|
| Rate for Payer: Multiplan Commercial |
$2,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,962.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,008.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,602.30
|
| Rate for Payer: Quartz Commercial |
$2,125.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,962.00
|
| Rate for Payer: The Alliance Commercial |
$13,080.00
|
| Rate for Payer: WEA Trust Commercial |
$1,798.50
|
| Rate for Payer: WPS Commercial |
$2,422.09
|
|
|
BALLOON EMERGE MR 1.5 X 15 391891515
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072581
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| 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 EMERGE MR 1.5 X 15 391891515
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.36 |
| Max. Negotiated Rate |
$9,148.00 |
| 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: The Alliance Commercial |
$9,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
BALLOON EMERGE MR 1.5 X 8 391890815
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
BALLOON EMERGE MR 1.5 X 8 391890815
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$7,616.00 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: The Alliance Commercial |
$7,616.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
BALLOON EMERGE MR 2.0 X 15 391891520
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072582
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| 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 EMERGE MR 2.0 X 15 391891520
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.36 |
| Max. Negotiated Rate |
$9,148.00 |
| 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: The Alliance Commercial |
$9,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
BALLOON EMERGE MR 2.0 X 20 391892020
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.36 |
| Max. Negotiated Rate |
$9,148.00 |
| 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: The Alliance Commercial |
$9,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
