|
BALLOON NC TREX 2.0x8mm #1012445-08
|
Facility
OP
|
$2,683.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.24 |
| Max. Negotiated Rate |
$2,468.36 |
| Rate for Payer: Aetna Commercial |
$2,414.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,307.38
|
| Rate for Payer: Aetna Managed Medicare |
$751.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,743.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,341.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,287.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,421.99
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,468.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,501.41
|
| Rate for Payer: Health EOS Commercial |
$2,387.87
|
| Rate for Payer: HFN Commercial |
$2,468.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,012.25
|
| Rate for Payer: Multiplan Commercial |
$2,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,609.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.67
|
| Rate for Payer: Quartz Commercial |
$1,743.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,609.80
|
| Rate for Payer: WEA Trust Commercial |
$1,475.65
|
| Rate for Payer: WPS Commercial |
$1,987.30
|
|
|
BALLOON NC TREX 2.0x8mm #1012445-08
|
Facility
IP
|
$2,683.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,314.67 |
| Max. Negotiated Rate |
$2,468.36 |
| Rate for Payer: Aetna Commercial |
$2,414.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,421.99
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,468.36
|
| Rate for Payer: Health EOS Commercial |
$2,387.87
|
| Rate for Payer: HFN Commercial |
$2,468.36
|
| Rate for Payer: Multiplan Commercial |
$2,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,609.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.67
|
| Rate for Payer: Quartz Commercial |
$1,609.80
|
| Rate for Payer: WEA Trust Commercial |
$1,475.65
|
| Rate for Payer: WPS Commercial |
$1,987.30
|
|
|
BALLOON NC TREX 3.50mm x 8mm x 143cm #1012451-08
|
Facility
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3493506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,023.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,377.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,828.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,755.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,046.46
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,742.75
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,377.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREX 3.50mm x 8mm x 143cm #1012451-08
|
Facility
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3493506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON PCB 5MM / 2CM / 90CM OTW PCB502090
|
Facility
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 5MM / 2CM / 90CM OTW PCB502090
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,110.36 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,899.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 6MM / 2CM / 90CM OTW
|
Facility
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 6MM / 2CM / 90CM OTW
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,110.36 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,899.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 7MM / 2CM / 90CM OTW
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,110.36 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,899.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 7MM / 2CM / 90CM OTW
|
Facility
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 8MM / 2CM / 90CM OTW
|
Facility
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 8MM / 2CM / 90CM OTW
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,110.36 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,899.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
Balloon-Peripheral .014
|
Facility
IP
|
$3,544.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,736.56 |
| Max. Negotiated Rate |
$3,260.48 |
| Rate for Payer: Aetna Commercial |
$3,189.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,878.32
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$3,260.48
|
| Rate for Payer: Health EOS Commercial |
$3,154.16
|
| Rate for Payer: HFN Commercial |
$3,260.48
|
| Rate for Payer: Multiplan Commercial |
$2,835.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,260.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.56
|
| Rate for Payer: Quartz Commercial |
$2,126.40
|
| Rate for Payer: WEA Trust Commercial |
$1,949.20
|
| Rate for Payer: WPS Commercial |
$2,625.04
|
|
|
Balloon-Peripheral .014
|
Facility
OP
|
$3,544.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$992.32 |
| Max. Negotiated Rate |
$3,260.48 |
| Rate for Payer: Aetna Commercial |
$3,189.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,047.84
|
| Rate for Payer: Aetna Managed Medicare |
$992.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,303.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,772.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,701.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,878.32
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$3,260.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,983.22
|
| Rate for Payer: Health EOS Commercial |
$3,154.16
|
| Rate for Payer: HFN Commercial |
$3,260.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,658.00
|
| Rate for Payer: Multiplan Commercial |
$2,835.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,260.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.56
|
| Rate for Payer: Quartz Commercial |
$2,303.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,126.40
|
| Rate for Payer: WEA Trust Commercial |
$1,949.20
|
| Rate for Payer: WPS Commercial |
$2,625.04
|
|
|
Balloon-Peripheral .035
|
Facility
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.52 |
| 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: 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: WEA Trust Commercial |
$871.20
|
| Rate for Payer: WPS Commercial |
$1,173.27
|
|
|
Balloon-Peripheral .035
|
Facility
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001129
|
|
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: 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-Peripheral Cutting .035
|
Facility
IP
|
$7,825.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,834.25 |
| Max. Negotiated Rate |
$7,199.00 |
| Rate for Payer: Aetna Commercial |
$7,042.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,147.25
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$7,199.00
|
| Rate for Payer: Health EOS Commercial |
$6,964.25
|
| Rate for Payer: HFN Commercial |
$7,199.00
|
| Rate for Payer: Multiplan Commercial |
$6,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,695.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,199.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,834.25
|
| Rate for Payer: Quartz Commercial |
$4,695.00
|
| Rate for Payer: WEA Trust Commercial |
$4,303.75
|
| Rate for Payer: WPS Commercial |
$5,795.98
|
|
|
Balloon-Peripheral Cutting .035
|
Facility
OP
|
$7,825.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,191.00 |
| Max. Negotiated Rate |
$7,199.00 |
| Rate for Payer: Aetna Commercial |
$7,042.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,729.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,191.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,086.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,912.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,756.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,147.25
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$7,199.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,378.87
|
| Rate for Payer: Health EOS Commercial |
$6,964.25
|
| Rate for Payer: HFN Commercial |
$7,199.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,868.75
|
| Rate for Payer: Multiplan Commercial |
$6,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,695.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,199.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,834.25
|
| Rate for Payer: Quartz Commercial |
$5,086.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,695.00
|
| Rate for Payer: WEA Trust Commercial |
$4,303.75
|
| Rate for Payer: WPS Commercial |
$5,795.98
|
|
|
BALLOON RETRIEVAL 9-12MM M00547100
|
Facility
OP
|
$1,450.00
|
|
| Hospital Charge Code |
4377219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$5,800.00 |
| Rate for Payer: Aetna Commercial |
$1,305.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,247.00
|
| Rate for Payer: Aetna Managed Medicare |
$406.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$942.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$725.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$696.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$768.50
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$1,334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$811.42
|
| Rate for Payer: Health EOS Commercial |
$1,290.50
|
| Rate for Payer: HFN Commercial |
$1,334.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,087.50
|
| Rate for Payer: Multiplan Commercial |
$1,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$870.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,334.00
|
| Rate for Payer: Quartz Beloit One Network |
$710.50
|
| Rate for Payer: Quartz Commercial |
$942.50
|
| Rate for Payer: Quartz Medicare Advantage |
$870.00
|
| Rate for Payer: The Alliance Commercial |
$5,800.00
|
| Rate for Payer: WEA Trust Commercial |
$797.50
|
| Rate for Payer: WPS Commercial |
$1,074.02
|
|
|
BALLOON RETRIEVAL 9-12MM M00547100
|
Facility
IP
|
$1,450.00
|
|
| Hospital Charge Code |
4377219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.50 |
| Max. Negotiated Rate |
$1,334.00 |
| Rate for Payer: Aetna Commercial |
$1,305.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$768.50
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$1,334.00
|
| Rate for Payer: Health EOS Commercial |
$1,290.50
|
| Rate for Payer: HFN Commercial |
$1,334.00
|
| Rate for Payer: Multiplan Commercial |
$1,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$870.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,334.00
|
| Rate for Payer: Quartz Beloit One Network |
$710.50
|
| Rate for Payer: Quartz Commercial |
$870.00
|
| Rate for Payer: WEA Trust Commercial |
$797.50
|
| Rate for Payer: WPS Commercial |
$1,074.02
|
|
|
BALLOON SIZING 47.5 mm 3441C
|
Facility
IP
|
$5,371.00
|
|
| Hospital Charge Code |
2973584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,631.79 |
| Max. Negotiated Rate |
$4,941.32 |
| Rate for Payer: Aetna Commercial |
$4,833.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,846.63
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cigna Commercial |
$4,941.32
|
| Rate for Payer: Health EOS Commercial |
$4,780.19
|
| Rate for Payer: HFN Commercial |
$4,941.32
|
| Rate for Payer: Multiplan Commercial |
$4,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,941.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,631.79
|
| Rate for Payer: Quartz Commercial |
$3,222.60
|
| Rate for Payer: WEA Trust Commercial |
$2,954.05
|
| Rate for Payer: WPS Commercial |
$3,978.30
|
|
|
BALLOON SIZING 47.5 mm 3441C
|
Facility
OP
|
$5,371.00
|
|
| Hospital Charge Code |
2973584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,503.88 |
| Max. Negotiated Rate |
$21,484.00 |
| Rate for Payer: Aetna Commercial |
$4,833.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,619.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,503.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,491.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,685.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,578.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,846.63
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cigna Commercial |
$4,941.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,005.61
|
| Rate for Payer: Health EOS Commercial |
$4,780.19
|
| Rate for Payer: HFN Commercial |
$4,941.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,028.25
|
| Rate for Payer: Multiplan Commercial |
$4,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,941.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,631.79
|
| Rate for Payer: Quartz Commercial |
$3,491.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,222.60
|
| Rate for Payer: The Alliance Commercial |
$21,484.00
|
| Rate for Payer: WEA Trust Commercial |
$2,954.05
|
| Rate for Payer: WPS Commercial |
$3,978.30
|
|
|
BALLOON TREK 3.0 X 8MM 1012274-08
|
Facility
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,023.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,377.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,828.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,755.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,046.46
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,742.75
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,377.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON TREK 3.0 X 8MM 1012274-08
|
Facility
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON TREK 3.5 X 8MM 1012276-08
|
Facility
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,023.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,377.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,828.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,755.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,046.46
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,742.75
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,377.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
