|
BALLOON FLEXTOME 2.5 X 15MM
|
Facility
|
OP
|
$6,401.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3533501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,863.97 |
| Max. Negotiated Rate |
$6,124.48 |
| Rate for Payer: Aetna Commercial |
$5,991.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,725.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,863.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,327.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,328.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,195.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,528.23
|
| Rate for Payer: Cash Price |
$1,920.30
|
| Rate for Payer: Cigna Commercial |
$6,124.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,725.38
|
| Rate for Payer: Health EOS Commercial |
$5,924.77
|
| Rate for Payer: HFN Commercial |
$6,124.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,992.78
|
| Rate for Payer: Multiplan Commercial |
$5,325.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,994.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.95
|
| Rate for Payer: Quartz Commercial |
$4,327.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,994.22
|
| Rate for Payer: The Alliance Commercial |
$3,328.52
|
| Rate for Payer: WEA Trust Commercial |
$3,661.37
|
| Rate for Payer: WPS Commercial |
$4,930.69
|
|
|
BALLOON FLEXTOME 2.5 X 15MM
|
Facility
|
IP
|
$6,401.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3533501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,261.95 |
| Max. Negotiated Rate |
$6,124.48 |
| Rate for Payer: Aetna Commercial |
$5,991.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,725.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,528.23
|
| Rate for Payer: Cash Price |
$1,920.30
|
| Rate for Payer: Cigna Commercial |
$6,124.48
|
| Rate for Payer: Health EOS Commercial |
$5,924.77
|
| Rate for Payer: HFN Commercial |
$6,124.48
|
| Rate for Payer: Multiplan Commercial |
$5,325.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,124.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.95
|
| Rate for Payer: Quartz Commercial |
$3,994.22
|
| Rate for Payer: WEA Trust Commercial |
$3,661.37
|
| Rate for Payer: WPS Commercial |
$4,930.69
|
|
|
BALLOON FLEXTOME CUTTING 3.0 X 15MM #CBM330015
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107477
|
|
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 FLEXTOME CUTTING 3.0 X 15MM #CBM330015
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107477
|
|
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 CUTTING RX 2.5 x 10mm #CBM325010
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107493
|
|
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 CUTTING RX 2.5 x 10mm #CBM325010
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107493
|
|
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 FLEXTOME CUTTING RX 3.0 x 10mm #CBM330010
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107494
|
|
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 CUTTING RX 3.0 x 10mm #CBM330010
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107494
|
|
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 FLEXTOME CUTTING RX 3.5 x 10mm #CBM335010
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107495
|
|
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 CUTTING RX 3.5 x 10mm #CBM335010
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107495
|
|
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 FLEXTOME ULTRA2 CUTTING 2.0x10
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107476
|
|
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 FLEXTOME ULTRA2 CUTTING 2.0x10
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3107476
|
|
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 I/A 8FR 50cc W/STATLOCK (2)
|
Facility
|
OP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,562.56 |
| Max. Negotiated Rate |
$8,419.84 |
| Rate for Payer: Aetna Commercial |
$8,236.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,870.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,562.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,948.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.56
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,419.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,121.60
|
| Rate for Payer: Health EOS Commercial |
$8,145.28
|
| Rate for Payer: HFN Commercial |
$8,419.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$7,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,491.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,419.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,484.48
|
| Rate for Payer: Quartz Commercial |
$5,948.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,491.20
|
| Rate for Payer: The Alliance Commercial |
$4,576.00
|
| Rate for Payer: WEA Trust Commercial |
$5,033.60
|
| Rate for Payer: WPS Commercial |
$6,778.64
|
|
|
BALLOON I/A 8FR 50cc W/STATLOCK (2)
|
Facility
|
IP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,484.48 |
| Max. Negotiated Rate |
$8,419.84 |
| Rate for Payer: Aetna Commercial |
$8,236.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,870.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.56
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,419.84
|
| Rate for Payer: Health EOS Commercial |
$8,145.28
|
| Rate for Payer: HFN Commercial |
$8,419.84
|
| Rate for Payer: Multiplan Commercial |
$7,321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,419.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,484.48
|
| Rate for Payer: Quartz Commercial |
$5,491.20
|
| Rate for Payer: WEA Trust Commercial |
$5,033.60
|
| Rate for Payer: WPS Commercial |
$6,778.64
|
|
|
BALLOON MAVERICK MONORAIL 2.0 X 15mm
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.0 X 15mm
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.0 X 20mm
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.0 X 20mm
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.0 X 9mm
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.0 X 9mm
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.5 X 15mm
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3171467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.5 X 15mm
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3171467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.5 X 20mm
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3171469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.5 X 20mm
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3171469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
BALLOON MAVERICK MONORAIL 2.5 X 9mm
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3393508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
