|
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
|
|
|
BALLOON PCB 6MM / 2CM / 90CM OTW
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,194.77 |
| 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: Aetna Managed Medicare |
$2,194.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,095.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,919.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,762.47
|
| 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: Dean Health DHI/DHP/ASO |
$4,386.53
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,878.86
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,703.09
|
| 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 |
$5,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,703.09
|
| Rate for Payer: The Alliance Commercial |
$3,919.24
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
|
BALLOON PCB 6MM / 2CM / 90CM OTW
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,840.86 |
| 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
|
|
|
BALLOON PCB 7MM / 2CM / 90CM OTW
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467517
|
|
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
|
|
|
BALLOON PCB 7MM / 2CM / 90CM OTW
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,194.77 |
| 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: Aetna Managed Medicare |
$2,194.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,095.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,919.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,762.47
|
| 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: Dean Health DHI/DHP/ASO |
$4,386.53
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,878.86
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,703.09
|
| 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 |
$5,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,703.09
|
| Rate for Payer: The Alliance Commercial |
$3,919.24
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
|
BALLOON PCB 8MM / 2CM / 90CM OTW
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467518
|
|
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
|
|
|
BALLOON PCB 8MM / 2CM / 90CM OTW
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,194.77 |
| 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: Aetna Managed Medicare |
$2,194.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,095.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,919.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,762.47
|
| 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: Dean Health DHI/DHP/ASO |
$4,386.53
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,878.86
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,703.09
|
| 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 |
$5,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,703.09
|
| Rate for Payer: The Alliance Commercial |
$3,919.24
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
|
Balloon-Peripheral .014
|
Facility
|
OP
|
$3,544.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.01 |
| Max. Negotiated Rate |
$3,390.90 |
| Rate for Payer: Aetna Commercial |
$3,317.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,169.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,032.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,395.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,842.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,953.45
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$3,390.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,062.61
|
| Rate for Payer: Health EOS Commercial |
$3,280.33
|
| Rate for Payer: HFN Commercial |
$3,390.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,764.32
|
| Rate for Payer: Multiplan Commercial |
$2,948.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,211.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,390.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,806.02
|
| Rate for Payer: Quartz Commercial |
$2,395.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,211.46
|
| Rate for Payer: The Alliance Commercial |
$1,842.88
|
| Rate for Payer: WEA Trust Commercial |
$2,027.17
|
| Rate for Payer: WPS Commercial |
$2,729.94
|
|
|
Balloon-Peripheral .014
|
Facility
|
IP
|
$3,544.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,806.02 |
| Max. Negotiated Rate |
$3,390.90 |
| Rate for Payer: Aetna Commercial |
$3,317.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,169.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,953.45
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$3,390.90
|
| Rate for Payer: Health EOS Commercial |
$3,280.33
|
| Rate for Payer: HFN Commercial |
$3,390.90
|
| Rate for Payer: Multiplan Commercial |
$2,948.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,390.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,806.02
|
| Rate for Payer: Quartz Commercial |
$2,211.46
|
| Rate for Payer: WEA Trust Commercial |
$2,027.17
|
| Rate for Payer: WPS Commercial |
$2,729.94
|
|
|
Balloon-Peripheral .035
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.21 |
| Max. Negotiated Rate |
$1,515.57 |
| Rate for Payer: Aetna Commercial |
$1,482.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.10
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$1,515.57
|
| Rate for Payer: Health EOS Commercial |
$1,466.15
|
| Rate for Payer: HFN Commercial |
$1,515.57
|
| Rate for Payer: Multiplan Commercial |
$1,317.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.57
|
| Rate for Payer: Quartz Beloit One Network |
$807.21
|
| Rate for Payer: Quartz Commercial |
$988.42
|
| Rate for Payer: WEA Trust Commercial |
$906.05
|
| Rate for Payer: WPS Commercial |
$1,220.16
|
|
|
Balloon-Peripheral .035
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.26 |
| Max. Negotiated Rate |
$1,515.57 |
| Rate for Payer: Aetna Commercial |
$1,482.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.73
|
| Rate for Payer: Aetna Managed Medicare |
$461.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.10
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$1,515.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.89
|
| Rate for Payer: Health EOS Commercial |
$1,466.15
|
| Rate for Payer: HFN Commercial |
$1,515.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.52
|
| Rate for Payer: Multiplan Commercial |
$1,317.89
|
| Rate for Payer: NAPHCARE Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.57
|
| Rate for Payer: Quartz Beloit One Network |
$807.21
|
| Rate for Payer: Quartz Commercial |
$1,070.78
|
| Rate for Payer: Quartz Medicare Advantage |
$988.42
|
| Rate for Payer: The Alliance Commercial |
$823.68
|
| Rate for Payer: WEA Trust Commercial |
$906.05
|
| Rate for Payer: WPS Commercial |
$1,220.16
|
|
|
Balloon-Peripheral Cutting .035
|
Facility
|
IP
|
$7,825.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,987.62 |
| Max. Negotiated Rate |
$7,486.96 |
| Rate for Payer: Aetna Commercial |
$7,324.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,998.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,313.14
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$7,486.96
|
| Rate for Payer: Health EOS Commercial |
$7,242.82
|
| Rate for Payer: HFN Commercial |
$7,486.96
|
| Rate for Payer: Multiplan Commercial |
$6,510.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,486.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,987.62
|
| Rate for Payer: Quartz Commercial |
$4,882.80
|
| Rate for Payer: WEA Trust Commercial |
$4,475.90
|
| Rate for Payer: WPS Commercial |
$6,027.60
|
|
|
Balloon-Peripheral Cutting .035
|
Facility
|
OP
|
$7,825.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4001130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,278.64 |
| Max. Negotiated Rate |
$7,486.96 |
| Rate for Payer: Aetna Commercial |
$7,324.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,998.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,278.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,289.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,069.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,906.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,313.14
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$7,486.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,554.15
|
| Rate for Payer: Health EOS Commercial |
$7,242.82
|
| Rate for Payer: HFN Commercial |
$7,486.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,103.50
|
| Rate for Payer: Multiplan Commercial |
$6,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,882.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,486.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,987.62
|
| Rate for Payer: Quartz Commercial |
$5,289.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,882.80
|
| Rate for Payer: The Alliance Commercial |
$4,069.00
|
| Rate for Payer: WEA Trust Commercial |
$4,475.90
|
| Rate for Payer: WPS Commercial |
$6,027.60
|
|
|
BALLOON RETRIEVAL 9-12MM M00547100
|
Facility
|
IP
|
$1,450.00
|
|
| Hospital Charge Code |
4377219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$738.92 |
| Max. Negotiated Rate |
$1,387.36 |
| Rate for Payer: Aetna Commercial |
$1,357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$799.24
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$1,387.36
|
| Rate for Payer: Health EOS Commercial |
$1,342.12
|
| Rate for Payer: HFN Commercial |
$1,387.36
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.36
|
| Rate for Payer: Quartz Beloit One Network |
$738.92
|
| Rate for Payer: Quartz Commercial |
$904.80
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.93
|
|
|
BALLOON RETRIEVAL 9-12MM M00547100
|
Facility
|
OP
|
$1,450.00
|
|
| Hospital Charge Code |
4377219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.24 |
| Max. Negotiated Rate |
$1,387.36 |
| Rate for Payer: Aetna Commercial |
$1,357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Aetna Managed Medicare |
$422.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$980.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$754.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$723.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$799.24
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$1,387.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$843.90
|
| Rate for Payer: Health EOS Commercial |
$1,342.12
|
| Rate for Payer: HFN Commercial |
$1,387.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,131.00
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.36
|
| Rate for Payer: Quartz Beloit One Network |
$738.92
|
| Rate for Payer: Quartz Commercial |
$980.20
|
| Rate for Payer: Quartz Medicare Advantage |
$904.80
|
| Rate for Payer: The Alliance Commercial |
$754.00
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.93
|
|
|
BALLOON-RX 3/5 X 15 MM CUTTING #H749CBM3350150
|
Facility
|
IP
|
$8,691.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,428.93 |
| Max. Negotiated Rate |
$8,315.55 |
| Rate for Payer: Aetna Commercial |
$8,134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,773.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,790.48
|
| Rate for Payer: Cash Price |
$2,607.30
|
| Rate for Payer: Cigna Commercial |
$8,315.55
|
| Rate for Payer: Health EOS Commercial |
$8,044.39
|
| Rate for Payer: HFN Commercial |
$8,315.55
|
| Rate for Payer: Multiplan Commercial |
$7,230.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,315.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,428.93
|
| Rate for Payer: Quartz Commercial |
$5,423.18
|
| Rate for Payer: WEA Trust Commercial |
$4,971.25
|
| Rate for Payer: WPS Commercial |
$6,694.68
|
|
|
BALLOON-RX 3/5 X 15 MM CUTTING #H749CBM3350150
|
Facility
|
OP
|
$8,691.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,530.82 |
| Max. Negotiated Rate |
$8,315.55 |
| Rate for Payer: Aetna Commercial |
$8,134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,773.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,530.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,875.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,519.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,338.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,790.48
|
| Rate for Payer: Cash Price |
$2,607.30
|
| Rate for Payer: Cigna Commercial |
$8,315.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,058.16
|
| Rate for Payer: Health EOS Commercial |
$8,044.39
|
| Rate for Payer: HFN Commercial |
$8,315.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,778.98
|
| Rate for Payer: Multiplan Commercial |
$7,230.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,423.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,315.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,428.93
|
| Rate for Payer: Quartz Commercial |
$5,875.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5,423.18
|
| Rate for Payer: The Alliance Commercial |
$4,519.32
|
| Rate for Payer: WEA Trust Commercial |
$4,971.25
|
| Rate for Payer: WPS Commercial |
$6,694.68
|
|
|
BALLOON SIZING 47.5 mm 3441C
|
Facility
|
OP
|
$5,371.00
|
|
| Hospital Charge Code |
2973584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,564.04 |
| Max. Negotiated Rate |
$5,138.97 |
| Rate for Payer: Aetna Commercial |
$5,027.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,803.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,564.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,630.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,792.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,960.50
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cigna Commercial |
$5,138.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,125.92
|
| Rate for Payer: Health EOS Commercial |
$4,971.40
|
| Rate for Payer: HFN Commercial |
$5,138.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,189.38
|
| Rate for Payer: Multiplan Commercial |
$4,468.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,351.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,138.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,737.06
|
| Rate for Payer: Quartz Commercial |
$3,630.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,351.50
|
| Rate for Payer: The Alliance Commercial |
$2,792.92
|
| Rate for Payer: WEA Trust Commercial |
$3,072.21
|
| Rate for Payer: WPS Commercial |
$4,137.28
|
|
|
BALLOON SIZING 47.5 mm 3441C
|
Facility
|
IP
|
$5,371.00
|
|
| Hospital Charge Code |
2973584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,737.06 |
| Max. Negotiated Rate |
$5,138.97 |
| Rate for Payer: Aetna Commercial |
$5,027.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,803.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,960.50
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cigna Commercial |
$5,138.97
|
| Rate for Payer: Health EOS Commercial |
$4,971.40
|
| Rate for Payer: HFN Commercial |
$5,138.97
|
| Rate for Payer: Multiplan Commercial |
$4,468.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,138.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,737.06
|
| Rate for Payer: Quartz Commercial |
$3,351.50
|
| Rate for Payer: WEA Trust Commercial |
$3,072.21
|
| Rate for Payer: WPS Commercial |
$4,137.28
|
|
|
BALLOON TREK 3.0 X 8MM 1012274-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473509
|
|
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 TREK 3.0 X 8MM 1012274-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473509
|
|
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 TREK 3.5 X 8MM 1012276-08
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473510
|
|
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 TREK 3.5 X 8MM 1012276-08
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3473510
|
|
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 TTS 10-12mm M00558620
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,368.79 |
| Max. Negotiated Rate |
$2,569.96 |
| Rate for Payer: Aetna Commercial |
$2,514.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,402.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.52
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,569.96
|
| Rate for Payer: Health EOS Commercial |
$2,486.16
|
| Rate for Payer: HFN Commercial |
$2,569.96
|
| Rate for Payer: Multiplan Commercial |
$2,234.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.79
|
| Rate for Payer: Quartz Commercial |
$1,676.06
|
| Rate for Payer: WEA Trust Commercial |
$1,536.39
|
| Rate for Payer: WPS Commercial |
$2,069.03
|
|
|
BALLOON TTS 10-12mm M00558620
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$782.16 |
| Max. Negotiated Rate |
$2,569.96 |
| Rate for Payer: Aetna Commercial |
$2,514.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,402.36
|
| Rate for Payer: Aetna Managed Medicare |
$782.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,815.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,396.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,340.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.52
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$2,569.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,563.25
|
| Rate for Payer: Health EOS Commercial |
$2,486.16
|
| Rate for Payer: HFN Commercial |
$2,569.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,095.08
|
| Rate for Payer: Multiplan Commercial |
$2,234.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.79
|
| Rate for Payer: Quartz Commercial |
$1,815.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,676.06
|
| Rate for Payer: The Alliance Commercial |
$1,396.72
|
| Rate for Payer: WEA Trust Commercial |
$1,536.39
|
| Rate for Payer: WPS Commercial |
$2,069.03
|
|
