|
BALLOON AVIATOR PTA 6 X 2 #424-6020W
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON AVIATOR PTA 6 X 2 #424-6020W
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON AVIATOR PTA 7 X 2 424-7020W
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON AVIATOR PTA 7 X 2 424-7020W
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON CATH ASCEND 4X4 G32834
|
Facility
|
IP
|
$2,698.00
|
|
| Hospital Charge Code |
2969465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,374.90 |
| Max. Negotiated Rate |
$2,581.45 |
| Rate for Payer: Aetna Commercial |
$2,525.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.14
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$2,581.45
|
| Rate for Payer: Health EOS Commercial |
$2,497.27
|
| Rate for Payer: HFN Commercial |
$2,581.45
|
| Rate for Payer: Multiplan Commercial |
$2,244.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,581.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,374.90
|
| Rate for Payer: Quartz Commercial |
$1,683.55
|
| Rate for Payer: WEA Trust Commercial |
$1,543.26
|
| Rate for Payer: WPS Commercial |
$2,078.27
|
|
|
BALLOON CATH ASCEND 4X4 G32834
|
Facility
|
OP
|
$2,698.00
|
|
| Hospital Charge Code |
2969465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$785.66 |
| Max. Negotiated Rate |
$2,581.45 |
| Rate for Payer: Aetna Commercial |
$2,525.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.09
|
| Rate for Payer: Aetna Managed Medicare |
$785.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,823.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,402.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,346.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.14
|
| Rate for Payer: Cash Price |
$809.40
|
| Rate for Payer: Cigna Commercial |
$2,581.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,570.24
|
| Rate for Payer: Health EOS Commercial |
$2,497.27
|
| Rate for Payer: HFN Commercial |
$2,581.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,104.44
|
| Rate for Payer: Multiplan Commercial |
$2,244.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,683.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,581.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,374.90
|
| Rate for Payer: Quartz Commercial |
$1,823.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,683.55
|
| Rate for Payer: The Alliance Commercial |
$1,402.96
|
| Rate for Payer: WEA Trust Commercial |
$1,543.26
|
| Rate for Payer: WPS Commercial |
$2,078.27
|
|
|
BALLOON CATH ASCEND 6X4 G32840
|
Facility
|
OP
|
$2,958.00
|
|
| Hospital Charge Code |
2965854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$861.37 |
| Max. Negotiated Rate |
$2,830.21 |
| Rate for Payer: Aetna Commercial |
$2,768.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,645.64
|
| Rate for Payer: Aetna Managed Medicare |
$861.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,999.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,538.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,476.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,630.45
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cigna Commercial |
$2,830.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,721.56
|
| Rate for Payer: Health EOS Commercial |
$2,737.92
|
| Rate for Payer: HFN Commercial |
$2,830.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,307.24
|
| Rate for Payer: Multiplan Commercial |
$2,461.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,845.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,830.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.40
|
| Rate for Payer: Quartz Commercial |
$1,999.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,845.79
|
| Rate for Payer: The Alliance Commercial |
$1,538.16
|
| Rate for Payer: WEA Trust Commercial |
$1,691.98
|
| Rate for Payer: WPS Commercial |
$2,278.55
|
|
|
BALLOON CATH ASCEND 6X4 G32840
|
Facility
|
IP
|
$2,958.00
|
|
| Hospital Charge Code |
2965854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,507.40 |
| Max. Negotiated Rate |
$2,830.21 |
| Rate for Payer: Aetna Commercial |
$2,768.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,645.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,630.45
|
| Rate for Payer: Cash Price |
$887.40
|
| Rate for Payer: Cigna Commercial |
$2,830.21
|
| Rate for Payer: Health EOS Commercial |
$2,737.92
|
| Rate for Payer: HFN Commercial |
$2,830.21
|
| Rate for Payer: Multiplan Commercial |
$2,461.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,830.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.40
|
| Rate for Payer: Quartz Commercial |
$1,845.79
|
| Rate for Payer: WEA Trust Commercial |
$1,691.98
|
| Rate for Payer: WPS Commercial |
$2,278.55
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 24FR X 12CM M0062101400
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5306863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.39 |
| Max. Negotiated Rate |
$2,779.50 |
| Rate for Payer: Aetna Commercial |
$2,719.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.24
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cigna Commercial |
$2,779.50
|
| Rate for Payer: Health EOS Commercial |
$2,688.87
|
| Rate for Payer: HFN Commercial |
$2,779.50
|
| Rate for Payer: Multiplan Commercial |
$2,416.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.39
|
| Rate for Payer: Quartz Commercial |
$1,812.72
|
| Rate for Payer: WEA Trust Commercial |
$1,661.66
|
| Rate for Payer: WPS Commercial |
$2,237.72
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 24FR X 12CM M0062101400
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5306863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.94 |
| Max. Negotiated Rate |
$2,779.50 |
| Rate for Payer: Aetna Commercial |
$2,719.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.23
|
| Rate for Payer: Aetna Managed Medicare |
$845.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,963.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,510.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.24
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Cigna Commercial |
$2,779.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,690.71
|
| Rate for Payer: Health EOS Commercial |
$2,688.87
|
| Rate for Payer: HFN Commercial |
$2,779.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.90
|
| Rate for Payer: Multiplan Commercial |
$2,416.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.39
|
| Rate for Payer: Quartz Commercial |
$1,963.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,812.72
|
| Rate for Payer: The Alliance Commercial |
$1,510.60
|
| Rate for Payer: WEA Trust Commercial |
$1,661.66
|
| Rate for Payer: WPS Commercial |
$2,237.72
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 30FR X 12CM M0062101170
|
Facility
|
OP
|
$2,742.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5384707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.47 |
| Max. Negotiated Rate |
$2,623.55 |
| Rate for Payer: Aetna Commercial |
$2,566.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,452.44
|
| Rate for Payer: Aetna Managed Medicare |
$798.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,853.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,425.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,368.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.39
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,623.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,595.84
|
| Rate for Payer: Health EOS Commercial |
$2,538.00
|
| Rate for Payer: HFN Commercial |
$2,623.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,138.76
|
| Rate for Payer: Multiplan Commercial |
$2,281.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,623.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.32
|
| Rate for Payer: Quartz Commercial |
$1,853.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.01
|
| Rate for Payer: The Alliance Commercial |
$1,425.84
|
| Rate for Payer: WEA Trust Commercial |
$1,568.42
|
| Rate for Payer: WPS Commercial |
$2,112.16
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 30FR X 12CM M0062101170
|
Facility
|
IP
|
$2,742.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5384707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,397.32 |
| Max. Negotiated Rate |
$2,623.55 |
| Rate for Payer: Aetna Commercial |
$2,566.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,452.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.39
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,623.55
|
| Rate for Payer: Health EOS Commercial |
$2,538.00
|
| Rate for Payer: HFN Commercial |
$2,623.55
|
| Rate for Payer: Multiplan Commercial |
$2,281.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,623.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.32
|
| Rate for Payer: Quartz Commercial |
$1,711.01
|
| Rate for Payer: WEA Trust Commercial |
$1,568.42
|
| Rate for Payer: WPS Commercial |
$2,112.16
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 30FR X 17CM M0062101620
|
Facility
|
OP
|
$3,279.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5415203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.84 |
| Max. Negotiated Rate |
$3,137.35 |
| Rate for Payer: Aetna Commercial |
$3,069.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,932.74
|
| Rate for Payer: Aetna Managed Medicare |
$954.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,216.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,705.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,636.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,807.38
|
| Rate for Payer: Cash Price |
$983.70
|
| Rate for Payer: Cigna Commercial |
$3,137.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,908.38
|
| Rate for Payer: Health EOS Commercial |
$3,035.04
|
| Rate for Payer: HFN Commercial |
$3,137.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,557.62
|
| Rate for Payer: Multiplan Commercial |
$2,728.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,046.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,137.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.98
|
| Rate for Payer: Quartz Commercial |
$2,216.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,046.10
|
| Rate for Payer: The Alliance Commercial |
$1,705.08
|
| Rate for Payer: WEA Trust Commercial |
$1,875.59
|
| Rate for Payer: WPS Commercial |
$2,525.81
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 30FR X 17CM M0062101620
|
Facility
|
IP
|
$3,279.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5415203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,670.98 |
| Max. Negotiated Rate |
$3,137.35 |
| Rate for Payer: Aetna Commercial |
$3,069.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,807.38
|
| Rate for Payer: Cash Price |
$983.70
|
| Rate for Payer: Cigna Commercial |
$3,137.35
|
| Rate for Payer: Health EOS Commercial |
$3,035.04
|
| Rate for Payer: HFN Commercial |
$3,137.35
|
| Rate for Payer: Multiplan Commercial |
$2,728.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,137.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.98
|
| Rate for Payer: Quartz Commercial |
$2,046.10
|
| Rate for Payer: WEA Trust Commercial |
$1,875.59
|
| Rate for Payer: WPS Commercial |
$2,525.81
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 30FR X 20CM PTFE M0062101440
|
Facility
|
OP
|
$2,909.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.10 |
| Max. Negotiated Rate |
$2,783.33 |
| Rate for Payer: Aetna Commercial |
$2,722.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,601.81
|
| Rate for Payer: Aetna Managed Medicare |
$847.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,966.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,512.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,452.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,603.44
|
| Rate for Payer: Cash Price |
$872.70
|
| Rate for Payer: Cigna Commercial |
$2,783.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,693.04
|
| Rate for Payer: Health EOS Commercial |
$2,692.57
|
| Rate for Payer: HFN Commercial |
$2,783.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,269.02
|
| Rate for Payer: Multiplan Commercial |
$2,420.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,815.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,783.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,482.43
|
| Rate for Payer: Quartz Commercial |
$1,966.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,815.22
|
| Rate for Payer: The Alliance Commercial |
$1,512.68
|
| Rate for Payer: WEA Trust Commercial |
$1,663.95
|
| Rate for Payer: WPS Commercial |
$2,240.80
|
|
|
BALLOON CATHETER NEPHROMAX HIGH PRESSURE 30FR X 20CM PTFE M0062101440
|
Facility
|
IP
|
$2,909.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5496948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,482.43 |
| Max. Negotiated Rate |
$2,783.33 |
| Rate for Payer: Aetna Commercial |
$2,722.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,601.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,603.44
|
| Rate for Payer: Cash Price |
$872.70
|
| Rate for Payer: Cigna Commercial |
$2,783.33
|
| Rate for Payer: Health EOS Commercial |
$2,692.57
|
| Rate for Payer: HFN Commercial |
$2,783.33
|
| Rate for Payer: Multiplan Commercial |
$2,420.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,783.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,482.43
|
| Rate for Payer: Quartz Commercial |
$1,815.22
|
| Rate for Payer: WEA Trust Commercial |
$1,663.95
|
| Rate for Payer: WPS Commercial |
$2,240.80
|
|
|
BALLOON CERVICAL RIPENING/STYLET G19891
|
Facility
|
IP
|
$849.00
|
|
| Hospital Charge Code |
5178771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.65 |
| Max. Negotiated Rate |
$812.32 |
| Rate for Payer: Aetna Commercial |
$794.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$812.32
|
| Rate for Payer: Health EOS Commercial |
$785.83
|
| Rate for Payer: HFN Commercial |
$812.32
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: Preferred Network Access Commercial |
$812.32
|
| Rate for Payer: Quartz Beloit One Network |
$432.65
|
| Rate for Payer: Quartz Commercial |
$529.78
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: WPS Commercial |
$653.98
|
|
|
BALLOON CERVICAL RIPENING/STYLET G19891
|
Facility
|
OP
|
$849.00
|
|
| Hospital Charge Code |
5178771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.23 |
| Max. Negotiated Rate |
$812.32 |
| Rate for Payer: Aetna Commercial |
$794.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Aetna Managed Medicare |
$247.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$812.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.12
|
| Rate for Payer: Health EOS Commercial |
$785.83
|
| Rate for Payer: HFN Commercial |
$812.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.22
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: NAPHCARE Commercial |
$529.78
|
| Rate for Payer: Preferred Network Access Commercial |
$812.32
|
| Rate for Payer: Quartz Beloit One Network |
$432.65
|
| Rate for Payer: Quartz Commercial |
$573.92
|
| Rate for Payer: Quartz Medicare Advantage |
$529.78
|
| Rate for Payer: The Alliance Commercial |
$441.48
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: WPS Commercial |
$653.98
|
|
|
BALLOON CONQUEST 10MM X 2CM X 75CM X 5.8F X .035 CQ75102
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6204998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.75 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,251.12
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
BALLOON CONQUEST 10MM X 2CM X 75CM X 5.8F X .035 CQ75102
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6204998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.86 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$583.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.91
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.90
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.12
|
| Rate for Payer: The Alliance Commercial |
$1,042.60
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
BALLOON CONQUEST 40 10MM X 2CM X 75CM X 5.8F X .035 CQF75102
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6204999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.75 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,251.12
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
BALLOON CONQUEST 40 10MM X 2CM X 75CM X 5.8F X .035 CQF75102
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6204999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.86 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$583.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.91
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.90
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.12
|
| Rate for Payer: The Alliance Commercial |
$1,042.60
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
BALLOON CONQUEST 40 10MM X 4CM X 75CM X 5.8F X .035 CQF75104
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6205000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.75 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,251.12
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
BALLOON CONQUEST 40 10MM X 4CM X 75CM X 5.8F X .035 CQF75104
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6205000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.86 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$583.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.91
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.90
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.12
|
| Rate for Payer: The Alliance Commercial |
$1,042.60
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
BALLOON CONQUEST 40 10MM X 8CM X 75CM X 5.8F X .035 CQF75108
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6205001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.86 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$583.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.91
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.90
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.12
|
| Rate for Payer: The Alliance Commercial |
$1,042.60
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
