|
BALLOON CONQUEST 9MM X 4CM X 75CM X 5.8F X .035 CQ7594
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6206976
|
|
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 9MM X 8CM X 75CM X 5.5F X .035 CQF7598
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6206966
|
|
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 9MM X 8CM X 75CM X 5.5F X .035 CQF7598
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6206966
|
|
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-Coronary Cutting
|
Facility
|
IP
|
$6,647.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,387.31 |
| Max. Negotiated Rate |
$6,359.85 |
| Rate for Payer: Aetna Commercial |
$6,221.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,945.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,663.83
|
| Rate for Payer: Cash Price |
$1,994.10
|
| Rate for Payer: Cigna Commercial |
$6,359.85
|
| Rate for Payer: Health EOS Commercial |
$6,152.46
|
| Rate for Payer: HFN Commercial |
$6,359.85
|
| Rate for Payer: Multiplan Commercial |
$5,530.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,359.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,387.31
|
| Rate for Payer: Quartz Commercial |
$4,147.73
|
| Rate for Payer: WEA Trust Commercial |
$3,802.08
|
| Rate for Payer: WPS Commercial |
$5,120.18
|
|
|
Balloon-Coronary Cutting
|
Facility
|
OP
|
$6,647.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,935.61 |
| Max. Negotiated Rate |
$6,359.85 |
| Rate for Payer: Aetna Commercial |
$6,221.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,945.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,935.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,493.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,456.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,318.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,663.83
|
| Rate for Payer: Cash Price |
$1,994.10
|
| Rate for Payer: Cigna Commercial |
$6,359.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,868.55
|
| Rate for Payer: Health EOS Commercial |
$6,152.46
|
| Rate for Payer: HFN Commercial |
$6,359.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,184.66
|
| Rate for Payer: Multiplan Commercial |
$5,530.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,147.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,359.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,387.31
|
| Rate for Payer: Quartz Commercial |
$4,493.37
|
| Rate for Payer: Quartz Medicare Advantage |
$4,147.73
|
| Rate for Payer: The Alliance Commercial |
$3,456.44
|
| Rate for Payer: WEA Trust Commercial |
$3,802.08
|
| Rate for Payer: WPS Commercial |
$5,120.18
|
|
|
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 |
$461.26 |
| Max. Negotiated Rate |
$1,515.57 |
| Rate for Payer: Aetna Commercial |
$1,482.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.73
|
| Rate for Payer: Aetna Managed Medicare |
$461.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.10
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$1,515.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.89
|
| Rate for Payer: Health EOS Commercial |
$1,466.15
|
| Rate for Payer: HFN Commercial |
$1,515.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.52
|
| Rate for Payer: Multiplan Commercial |
$1,317.89
|
| Rate for Payer: NAPHCARE Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.57
|
| Rate for Payer: Quartz Beloit One Network |
$807.21
|
| Rate for Payer: Quartz Commercial |
$1,070.78
|
| Rate for Payer: Quartz Medicare Advantage |
$988.42
|
| Rate for Payer: The Alliance Commercial |
$823.68
|
| Rate for Payer: WEA Trust Commercial |
$906.05
|
| Rate for Payer: WPS Commercial |
$1,220.16
|
|
|
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 |
$807.21 |
| Max. Negotiated Rate |
$1,515.57 |
| Rate for Payer: Aetna Commercial |
$1,482.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.10
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$1,515.57
|
| Rate for Payer: Health EOS Commercial |
$1,466.15
|
| Rate for Payer: HFN Commercial |
$1,515.57
|
| Rate for Payer: Multiplan Commercial |
$1,317.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.57
|
| Rate for Payer: Quartz Beloit One Network |
$807.21
|
| Rate for Payer: Quartz Commercial |
$988.42
|
| Rate for Payer: WEA Trust Commercial |
$906.05
|
| Rate for Payer: WPS Commercial |
$1,220.16
|
|
|
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 |
$860.50 |
| Max. Negotiated Rate |
$2,827.34 |
| Rate for Payer: Aetna Commercial |
$2,765.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.95
|
| Rate for Payer: Aetna Managed Medicare |
$860.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,997.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,536.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,475.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.80
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,827.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,719.81
|
| Rate for Payer: Health EOS Commercial |
$2,735.15
|
| Rate for Payer: HFN Commercial |
$2,827.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.90
|
| Rate for Payer: Multiplan Commercial |
$2,458.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,827.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.87
|
| Rate for Payer: Quartz Commercial |
$1,997.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,843.92
|
| Rate for Payer: The Alliance Commercial |
$1,536.60
|
| Rate for Payer: WEA Trust Commercial |
$1,690.26
|
| Rate for Payer: WPS Commercial |
$2,276.24
|
|
|
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 |
$1,505.87 |
| Max. Negotiated Rate |
$2,827.34 |
| Rate for Payer: Aetna Commercial |
$2,765.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.80
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,827.34
|
| Rate for Payer: Health EOS Commercial |
$2,735.15
|
| Rate for Payer: HFN Commercial |
$2,827.34
|
| Rate for Payer: Multiplan Commercial |
$2,458.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,827.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.87
|
| Rate for Payer: Quartz Commercial |
$1,843.92
|
| Rate for Payer: WEA Trust Commercial |
$1,690.26
|
| Rate for Payer: WPS Commercial |
$2,276.24
|
|
|
BALLOON DILATION
|
Facility
|
IP
|
$1,086.00
|
|
| Hospital Charge Code |
2960550
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$553.43 |
| Max. Negotiated Rate |
$1,039.08 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.60
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,039.08
|
| Rate for Payer: Health EOS Commercial |
$1,005.20
|
| Rate for Payer: HFN Commercial |
$1,039.08
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.08
|
| Rate for Payer: Quartz Beloit One Network |
$553.43
|
| Rate for Payer: Quartz Commercial |
$677.66
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BALLOON DILATION
|
Facility
|
OP
|
$1,086.00
|
|
| Hospital Charge Code |
2960550
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$316.24 |
| Max. Negotiated Rate |
$1,039.08 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Aetna Managed Medicare |
$316.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$734.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$564.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$542.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.60
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,039.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$632.05
|
| Rate for Payer: Health EOS Commercial |
$1,005.20
|
| Rate for Payer: HFN Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$847.08
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: NAPHCARE Commercial |
$677.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.08
|
| Rate for Payer: Quartz Beloit One Network |
$553.43
|
| Rate for Payer: Quartz Commercial |
$734.14
|
| Rate for Payer: Quartz Medicare Advantage |
$677.66
|
| Rate for Payer: The Alliance Commercial |
$564.72
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
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 |
$1,957.88 |
| Max. Negotiated Rate |
$3,676.03 |
| Rate for Payer: Aetna Commercial |
$3,596.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,436.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,117.71
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cigna Commercial |
$3,676.03
|
| Rate for Payer: Health EOS Commercial |
$3,556.16
|
| Rate for Payer: HFN Commercial |
$3,676.03
|
| Rate for Payer: Multiplan Commercial |
$3,196.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,676.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,957.88
|
| Rate for Payer: Quartz Commercial |
$2,397.41
|
| Rate for Payer: WEA Trust Commercial |
$2,197.62
|
| Rate for Payer: WPS Commercial |
$2,959.49
|
|
|
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 |
$1,118.79 |
| Max. Negotiated Rate |
$3,676.03 |
| Rate for Payer: Aetna Commercial |
$3,596.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,436.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,118.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,597.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,997.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,917.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,117.71
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cigna Commercial |
$3,676.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,236.04
|
| Rate for Payer: Health EOS Commercial |
$3,556.16
|
| Rate for Payer: HFN Commercial |
$3,676.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,996.76
|
| Rate for Payer: Multiplan Commercial |
$3,196.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,397.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,676.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,957.88
|
| Rate for Payer: Quartz Commercial |
$2,597.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,397.41
|
| Rate for Payer: The Alliance Commercial |
$1,997.84
|
| Rate for Payer: WEA Trust Commercial |
$2,197.62
|
| Rate for Payer: WPS Commercial |
$2,959.49
|
|
|
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 |
$1,505.87 |
| Max. Negotiated Rate |
$2,827.34 |
| Rate for Payer: Aetna Commercial |
$2,765.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.80
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,827.34
|
| Rate for Payer: Health EOS Commercial |
$2,735.15
|
| Rate for Payer: HFN Commercial |
$2,827.34
|
| Rate for Payer: Multiplan Commercial |
$2,458.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,827.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.87
|
| Rate for Payer: Quartz Commercial |
$1,843.92
|
| Rate for Payer: WEA Trust Commercial |
$1,690.26
|
| Rate for Payer: WPS Commercial |
$2,276.24
|
|
|
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 |
$860.50 |
| Max. Negotiated Rate |
$2,827.34 |
| Rate for Payer: Aetna Commercial |
$2,765.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.95
|
| Rate for Payer: Aetna Managed Medicare |
$860.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,997.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,536.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,475.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.80
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,827.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,719.81
|
| Rate for Payer: Health EOS Commercial |
$2,735.15
|
| Rate for Payer: HFN Commercial |
$2,827.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.90
|
| Rate for Payer: Multiplan Commercial |
$2,458.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,827.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.87
|
| Rate for Payer: Quartz Commercial |
$1,997.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,843.92
|
| Rate for Payer: The Alliance Commercial |
$1,536.60
|
| Rate for Payer: WEA Trust Commercial |
$1,690.26
|
| Rate for Payer: WPS Commercial |
$2,276.24
|
|
|
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 |
$950.77 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Aetna Managed Medicare |
$950.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,207.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,697.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,629.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.23
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,546.70
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,207.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,037.36
|
| Rate for Payer: The Alliance Commercial |
$1,697.80
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
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 |
$1,663.84 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,037.36
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
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 |
$950.77 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Aetna Managed Medicare |
$950.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,207.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,697.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,629.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.23
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,546.70
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,207.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,037.36
|
| Rate for Payer: The Alliance Commercial |
$1,697.80
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
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 |
$1,663.84 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,037.36
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
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 |
$1,666.39 |
| Max. Negotiated Rate |
$3,128.74 |
| Rate for Payer: Aetna Commercial |
$3,060.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,924.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,802.42
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna Commercial |
$3,128.74
|
| Rate for Payer: Health EOS Commercial |
$3,026.71
|
| Rate for Payer: HFN Commercial |
$3,128.74
|
| Rate for Payer: Multiplan Commercial |
$2,720.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,128.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,666.39
|
| Rate for Payer: Quartz Commercial |
$2,040.48
|
| Rate for Payer: WEA Trust Commercial |
$1,870.44
|
| Rate for Payer: WPS Commercial |
$2,518.88
|
|
|
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 |
$952.22 |
| Max. Negotiated Rate |
$3,128.74 |
| Rate for Payer: Aetna Commercial |
$3,060.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,924.69
|
| Rate for Payer: Aetna Managed Medicare |
$952.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,210.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,700.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,632.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,802.42
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna Commercial |
$3,128.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,903.14
|
| Rate for Payer: Health EOS Commercial |
$3,026.71
|
| Rate for Payer: HFN Commercial |
$3,128.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,550.60
|
| Rate for Payer: Multiplan Commercial |
$2,720.64
|
| Rate for Payer: NAPHCARE Commercial |
$2,040.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,128.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,666.39
|
| Rate for Payer: Quartz Commercial |
$2,210.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,040.48
|
| Rate for Payer: The Alliance Commercial |
$1,700.40
|
| Rate for Payer: WEA Trust Commercial |
$1,870.44
|
| Rate for Payer: WPS Commercial |
$2,518.88
|
|
|
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 |
$1,165.46 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,427.09
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
BALLOON 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 |
$665.97 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Aetna Managed Medicare |
$665.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.03
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.86
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,546.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.09
|
| Rate for Payer: The Alliance Commercial |
$1,189.24
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
BALLOON 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 |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
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 |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
