|
BALLOON TTS 12-15mm M00558630
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973218
|
|
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
|
|
|
BALLOON TTS 12-15mm M00558630
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973218
|
|
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 15-18mm M00558640
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973219
|
|
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 15-18mm M00558640
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973219
|
|
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
|
|
|
BALLOON TTS 18-20mm M00558650
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973222
|
|
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
|
|
|
BALLOON TTS 18-20mm M00558650
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973222
|
|
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 8-10mm M00558610
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973216
|
|
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 8-10mm M00558610
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973216
|
|
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
|
|
|
BALLOON TTS COLONIC 10-12mm M00558680
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.04 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Aetna Managed Medicare |
$753.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,748.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,505.05
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,017.08
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,748.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.66
|
| Rate for Payer: The Alliance Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 10-12mm M00558680
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.83 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,613.66
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 12-15mm M00558690
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.04 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Aetna Managed Medicare |
$753.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,748.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,505.05
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,017.08
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,748.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.66
|
| Rate for Payer: The Alliance Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 12-15mm M00558690
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.83 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,613.66
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 15-18mm M00558700
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.83 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,613.66
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 15-18mm M00558700
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.04 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Aetna Managed Medicare |
$753.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,748.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,505.05
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,017.08
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,748.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.66
|
| Rate for Payer: The Alliance Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 18-20mm M00558710
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.04 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Aetna Managed Medicare |
$753.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,748.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,505.05
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,017.08
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,748.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.66
|
| Rate for Payer: The Alliance Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 18-20mm M00558710
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.83 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,613.66
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
BALLOON TTS COLONIC 8-10mm M00558670
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973309
|
|
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
|
|
|
BALLOON TTS COLONIC 8-10mm M00558670
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
2973309
|
|
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 ULTRAVERSE 35 3MM X 2CM X 75CM X 5F X .035 U357532
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$826.80
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
BALLOON ULTRAVERSE 35 3MM X 2CM X 75CM X 5F X .035 U357532
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Aetna Managed Medicare |
$385.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.15
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: NAPHCARE Commercial |
$826.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$895.70
|
| Rate for Payer: Quartz Medicare Advantage |
$826.80
|
| Rate for Payer: The Alliance Commercial |
$689.00
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
BALLOON ULTRAVERSE 35 4MM X 2CM X 75CM X 5F X .035 U357542
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$826.80
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
BALLOON ULTRAVERSE 35 4MM X 2CM X 75CM X 5F X .035 U357542
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Aetna Managed Medicare |
$385.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.15
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: NAPHCARE Commercial |
$826.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$895.70
|
| Rate for Payer: Quartz Medicare Advantage |
$826.80
|
| Rate for Payer: The Alliance Commercial |
$689.00
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
BALLOON ULTRAVERSE 35 5MM X 2CM X 75CM X 5F X .035 U357552
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Aetna Managed Medicare |
$385.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.15
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: NAPHCARE Commercial |
$826.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$895.70
|
| Rate for Payer: Quartz Medicare Advantage |
$826.80
|
| Rate for Payer: The Alliance Commercial |
$689.00
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
BALLOON ULTRAVERSE 35 5MM X 2CM X 75CM X 5F X .035 U357552
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$826.80
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
BALLOON ULTRAVERSE 35 6MM X 2CM X 75CM X 5F X .035 U357562
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
6207016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Aetna Managed Medicare |
$385.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.15
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: NAPHCARE Commercial |
$826.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$895.70
|
| Rate for Payer: Quartz Medicare Advantage |
$826.80
|
| Rate for Payer: The Alliance Commercial |
$689.00
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
