|
BALLOON NC TREK 2.5 X 12
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3529511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
BALLOON NC TREK 2.5 X 12
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3529511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
BALLOON NC TREK 2.5x8mm #1012447-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,367.26 |
| Max. Negotiated Rate |
$2,567.09 |
| Rate for Payer: Aetna Commercial |
$2,511.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.87
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,567.09
|
| Rate for Payer: Health EOS Commercial |
$2,483.38
|
| Rate for Payer: HFN Commercial |
$2,567.09
|
| Rate for Payer: Multiplan Commercial |
$2,232.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.26
|
| Rate for Payer: Quartz Commercial |
$1,674.19
|
| Rate for Payer: WEA Trust Commercial |
$1,534.68
|
| Rate for Payer: WPS Commercial |
$2,066.71
|
|
|
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 |
$781.29 |
| Max. Negotiated Rate |
$2,567.09 |
| Rate for Payer: Aetna Commercial |
$2,511.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.68
|
| Rate for Payer: Aetna Managed Medicare |
$781.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.87
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,567.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.51
|
| Rate for Payer: Health EOS Commercial |
$2,483.38
|
| Rate for Payer: HFN Commercial |
$2,567.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.74
|
| Rate for Payer: Multiplan Commercial |
$2,232.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.26
|
| Rate for Payer: Quartz Commercial |
$1,813.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.19
|
| Rate for Payer: The Alliance Commercial |
$1,395.16
|
| Rate for Payer: WEA Trust Commercial |
$1,534.68
|
| Rate for Payer: WPS Commercial |
$2,066.71
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,863.61 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,281.97
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$1,064.92 |
| Max. Negotiated Rate |
$3,499.02 |
| Rate for Payer: Aetna Commercial |
$3,422.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,270.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,472.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,901.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,825.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.74
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$3,499.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,128.37
|
| Rate for Payer: Health EOS Commercial |
$3,384.92
|
| Rate for Payer: HFN Commercial |
$3,499.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,852.46
|
| Rate for Payer: Multiplan Commercial |
$3,042.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,499.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,863.61
|
| Rate for Payer: Quartz Commercial |
$2,472.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.97
|
| Rate for Payer: The Alliance Commercial |
$1,901.64
|
| Rate for Payer: WEA Trust Commercial |
$2,091.80
|
| Rate for Payer: WPS Commercial |
$2,816.99
|
|
|
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 |
$3,840.86 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$4,703.09
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
