|
BALLOON EMERGE MR 3.5 X 15 391891535
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072585
|
|
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 3.5 X 20 391892035
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072590
|
|
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 3.5 X 20 391892035
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072590
|
|
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 3.5 X 30 391893035
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072595
|
|
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 3.5 X 30 391893035
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072595
|
|
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 3.5 X 8 391890835
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072579
|
|
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 3.5 X 8 391890835
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072579
|
|
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 4.0 X 15 391891540
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072586
|
|
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 4.0 X 15 391891540
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072586
|
|
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 4.0 X 20 391892040
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072591
|
|
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 4.0 X 20 391892040
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072591
|
|
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 4.0 X 8 391890840
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072580
|
|
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 4.0 X 8 391890840
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3072580
|
|
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 EVERCROSS 3.0 x 60mm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972482
|
|
Hospital Revenue Code
|
278
|
| 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 EVERCROSS 3.0 x 60mm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972482
|
|
Hospital Revenue Code
|
278
|
| 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 EVERCROSS 9mm X 80mm
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2972935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.62
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$1,189.76
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
BALLOON EVERCROSS 9mm X 80mm
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2972935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
BALLOON EXTRACTOR 12-15mm M00547010
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2972909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$668.89 |
| Max. Negotiated Rate |
$2,197.77 |
| Rate for Payer: Aetna Commercial |
$2,149.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,054.44
|
| Rate for Payer: Aetna Managed Medicare |
$668.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,552.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,194.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,146.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.11
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$2,197.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,336.85
|
| Rate for Payer: Health EOS Commercial |
$2,126.10
|
| Rate for Payer: HFN Commercial |
$2,197.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,791.66
|
| Rate for Payer: Multiplan Commercial |
$1,911.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,433.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,197.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,170.55
|
| Rate for Payer: Quartz Commercial |
$1,552.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,433.33
|
| Rate for Payer: The Alliance Commercial |
$1,194.44
|
| Rate for Payer: WEA Trust Commercial |
$1,313.88
|
| Rate for Payer: WPS Commercial |
$1,769.38
|
|
|
BALLOON EXTRACTOR 12-15mm M00547010
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2972909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.55 |
| Max. Negotiated Rate |
$2,197.77 |
| Rate for Payer: Aetna Commercial |
$2,149.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,054.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.11
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$2,197.77
|
| Rate for Payer: Health EOS Commercial |
$2,126.10
|
| Rate for Payer: HFN Commercial |
$2,197.77
|
| Rate for Payer: Multiplan Commercial |
$1,911.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,197.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,170.55
|
| Rate for Payer: Quartz Commercial |
$1,433.33
|
| Rate for Payer: WEA Trust Commercial |
$1,313.88
|
| Rate for Payer: WPS Commercial |
$1,769.38
|
|
|
BALLOON EXTRACTOR 15-18mm 4702
|
Facility
|
OP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
3211484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.18 |
| Max. Negotiated Rate |
$2,198.73 |
| Rate for Payer: Aetna Commercial |
$2,150.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,055.33
|
| Rate for Payer: Aetna Managed Medicare |
$669.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,553.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,194.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,147.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.66
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,198.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,337.44
|
| Rate for Payer: Health EOS Commercial |
$2,127.03
|
| Rate for Payer: HFN Commercial |
$2,198.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,792.44
|
| Rate for Payer: Multiplan Commercial |
$1,911.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,433.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,198.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,171.06
|
| Rate for Payer: Quartz Commercial |
$1,553.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,433.95
|
| Rate for Payer: The Alliance Commercial |
$1,194.96
|
| Rate for Payer: WEA Trust Commercial |
$1,314.46
|
| Rate for Payer: WPS Commercial |
$1,770.15
|
|
|
BALLOON EXTRACTOR 15-18mm 4702
|
Facility
|
IP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
3211484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,171.06 |
| Max. Negotiated Rate |
$2,198.73 |
| Rate for Payer: Aetna Commercial |
$2,150.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,055.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.66
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,198.73
|
| Rate for Payer: Health EOS Commercial |
$2,127.03
|
| Rate for Payer: HFN Commercial |
$2,198.73
|
| Rate for Payer: Multiplan Commercial |
$1,911.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,198.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,171.06
|
| Rate for Payer: Quartz Commercial |
$1,433.95
|
| Rate for Payer: WEA Trust Commercial |
$1,314.46
|
| Rate for Payer: WPS Commercial |
$1,770.15
|
|
|
BALLOON EXTRACTOR 9-12mm M00547000
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2972908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$668.89 |
| Max. Negotiated Rate |
$2,197.77 |
| Rate for Payer: Aetna Commercial |
$2,149.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,054.44
|
| Rate for Payer: Aetna Managed Medicare |
$668.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,552.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,194.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,146.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.11
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$2,197.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,336.85
|
| Rate for Payer: Health EOS Commercial |
$2,126.10
|
| Rate for Payer: HFN Commercial |
$2,197.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,791.66
|
| Rate for Payer: Multiplan Commercial |
$1,911.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,433.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,197.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,170.55
|
| Rate for Payer: Quartz Commercial |
$1,552.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,433.33
|
| Rate for Payer: The Alliance Commercial |
$1,194.44
|
| Rate for Payer: WEA Trust Commercial |
$1,313.88
|
| Rate for Payer: WPS Commercial |
$1,769.38
|
|
|
BALLOON EXTRACTOR 9-12mm M00547000
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2972908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.55 |
| Max. Negotiated Rate |
$2,197.77 |
| Rate for Payer: Aetna Commercial |
$2,149.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,054.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,266.11
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$2,197.77
|
| Rate for Payer: Health EOS Commercial |
$2,126.10
|
| Rate for Payer: HFN Commercial |
$2,197.77
|
| Rate for Payer: Multiplan Commercial |
$1,911.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,197.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,170.55
|
| Rate for Payer: Quartz Commercial |
$1,433.33
|
| Rate for Payer: WEA Trust Commercial |
$1,313.88
|
| Rate for Payer: WPS Commercial |
$1,769.38
|
|
|
BALLOON FLEXTOME 2.00x15mm CUTTING-RX
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107496
|
|
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
|
|
|
BALLOON FLEXTOME 2.00x15mm CUTTING-RX
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107496
|
|
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
|
|
