|
BALLOON NC TREK 2.5x8mm #1012447-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 2.75 X 12MM 1012448-12
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 2.75 X 12MM 1012448-12
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 2.75 x 8mm #1012448-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 2.75 x 8mm #1012448-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 3.0 X 12MM 1012449-12
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3705499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 3.0 X 12MM 1012449-12
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3705499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 3.5 X 12MM 1012451-12
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 3.5 X 12MM 1012451-12
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 4.0 X 12MM 1012453-12
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 4.0 X 12MM 1012453-12
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 4.0x8mm #1012453-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 4.0x8mm #1012453-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 4.5 x 8mm #1012454-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3557512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREK 4.5 x 8mm #1012454-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3557512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREX 2.0x8mm #1012445-08
|
Facility
|
IP
|
$2,683.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,314.67 |
| Max. Negotiated Rate |
$2,468.36 |
| Rate for Payer: Aetna Commercial |
$2,414.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,307.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,421.99
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,468.36
|
| Rate for Payer: Health EOS Commercial |
$2,387.87
|
| Rate for Payer: HFN Commercial |
$2,468.36
|
| Rate for Payer: Multiplan Commercial |
$2,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,609.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.67
|
| Rate for Payer: Quartz Commercial |
$1,609.80
|
| Rate for Payer: WEA Trust Commercial |
$1,475.65
|
| Rate for Payer: WPS Commercial |
$1,987.30
|
|
|
BALLOON NC TREX 2.0x8mm #1012445-08
|
Facility
|
OP
|
$2,683.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.24 |
| Max. Negotiated Rate |
$10,732.00 |
| Rate for Payer: Aetna Commercial |
$2,414.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,307.38
|
| Rate for Payer: Aetna Managed Medicare |
$751.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,743.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,341.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,287.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,421.99
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,468.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,501.41
|
| Rate for Payer: Health EOS Commercial |
$2,387.87
|
| Rate for Payer: HFN Commercial |
$2,468.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,012.25
|
| Rate for Payer: Multiplan Commercial |
$2,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,609.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.67
|
| Rate for Payer: Quartz Commercial |
$1,743.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,609.80
|
| Rate for Payer: The Alliance Commercial |
$10,732.00
|
| Rate for Payer: WEA Trust Commercial |
$1,475.65
|
| Rate for Payer: WPS Commercial |
$1,987.30
|
|
|
BALLOON NC TREX 3.0 x 8mm x 143cm #1012449-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3493505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREX 3.0 x 8mm x 143cm #1012449-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3493505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREX 3.50mm x 8mm x 143cm #1012451-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3493506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,791.93 |
| Max. Negotiated Rate |
$3,364.44 |
| Rate for Payer: Aetna Commercial |
$3,291.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.21
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,364.44
|
| Rate for Payer: Health EOS Commercial |
$3,254.73
|
| Rate for Payer: HFN Commercial |
$3,364.44
|
| Rate for Payer: Multiplan Commercial |
$2,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,364.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.93
|
| Rate for Payer: Quartz Commercial |
$2,194.20
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON NC TREX 3.50mm x 8mm x 143cm #1012451-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3493506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.96 |
| Max. Negotiated Rate |
$14,628.00 |
| 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: The Alliance Commercial |
$14,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,011.35
|
| Rate for Payer: WPS Commercial |
$2,708.74
|
|
|
BALLOON PCB 5MM / 2CM / 90CM OTW PCB502090
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,110.36 |
| Max. Negotiated Rate |
$30,148.00 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,899.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: The Alliance Commercial |
$30,148.00
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 5MM / 2CM / 90CM OTW PCB502090
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 6MM / 2CM / 90CM OTW
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,110.36 |
| Max. Negotiated Rate |
$30,148.00 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,899.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: The Alliance Commercial |
$30,148.00
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
BALLOON PCB 6MM / 2CM / 90CM OTW
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
