|
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
|
|
|
BALLOON TTS 10-12mm M00558620
|
Facility
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.08 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.96
|
| Rate for Payer: Aetna Managed Medicare |
$752.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.09
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,745.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 10-12mm M00558620
|
Facility
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.14 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 12-15mm M00558630
|
Facility
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.14 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 12-15mm M00558630
|
Facility
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.08 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.96
|
| Rate for Payer: Aetna Managed Medicare |
$752.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.09
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,745.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 15-18mm M00558640
|
Facility
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.14 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 15-18mm M00558640
|
Facility
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.08 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.96
|
| Rate for Payer: Aetna Managed Medicare |
$752.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.09
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,745.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 18-20mm M00558650
|
Facility
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.14 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 18-20mm M00558650
|
Facility
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.08 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.96
|
| Rate for Payer: Aetna Managed Medicare |
$752.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.09
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,745.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 8-10mm M00558610
|
Facility
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.08 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.96
|
| Rate for Payer: Aetna Managed Medicare |
$752.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.09
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,745.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS 8-10mm M00558610
|
Facility
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.14 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS COLONIC 10-12mm M00558680
|
Facility
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,267.14 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 10-12mm M00558680
|
Facility
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.08 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Aetna Managed Medicare |
$724.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,241.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,447.13
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,939.50
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,680.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 12-15mm M00558690
|
Facility
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.08 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Aetna Managed Medicare |
$724.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,241.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,447.13
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,939.50
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,680.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 12-15mm M00558690
|
Facility
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,267.14 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 15-18mm M00558700
|
Facility
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.08 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Aetna Managed Medicare |
$724.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,241.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,447.13
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,939.50
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,680.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 15-18mm M00558700
|
Facility
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,267.14 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 18-20mm M00558710
|
Facility
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.08 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Aetna Managed Medicare |
$724.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,241.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,447.13
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,939.50
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,680.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 18-20mm M00558710
|
Facility
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,267.14 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
BALLOON TTS COLONIC 8-10mm M00558670
|
Facility
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.08 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.96
|
| Rate for Payer: Aetna Managed Medicare |
$752.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.09
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,745.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON TTS COLONIC 8-10mm M00558670
|
Facility
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.14 |
| Max. Negotiated Rate |
$2,471.12 |
| Rate for Payer: Aetna Commercial |
$2,417.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.58
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,471.12
|
| Rate for Payer: Health EOS Commercial |
$2,390.54
|
| Rate for Payer: HFN Commercial |
$2,471.12
|
| Rate for Payer: Multiplan Commercial |
$2,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.14
|
| Rate for Payer: Quartz Commercial |
$1,611.60
|
| Rate for Payer: WEA Trust Commercial |
$1,477.30
|
| Rate for Payer: WPS Commercial |
$1,989.52
|
|
|
BALLOON ULTRAVERSE 35 3MM X 2CM X 75CM X 5F X .035 U357532
|
Facility
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.25 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$795.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
BALLOON ULTRAVERSE 35 3MM X 2CM X 75CM X 5F X .035 U357532
|
Facility
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.50
|
| Rate for Payer: Aetna Managed Medicare |
$371.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.75
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$861.25
|
| Rate for Payer: Quartz Medicare Advantage |
$795.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
BALLOON ULTRAVERSE 35 4MM X 2CM X 75CM X 5F X .035 U357542
|
Facility
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.25 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$795.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
BALLOON ULTRAVERSE 35 4MM X 2CM X 75CM X 5F X .035 U357542
|
Facility
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.50
|
| Rate for Payer: Aetna Managed Medicare |
$371.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.75
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$861.25
|
| Rate for Payer: Quartz Medicare Advantage |
$795.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
