|
BALLOON MUSTANG 7 x 40x 40CM 39171-07044
|
Facility
OP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.68 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,402.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,107.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,571.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,898.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,213.78
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,967.00
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,571.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 7 x 40x 40CM 39171-07044
|
Facility
IP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.44 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 7 x 80x 40CM
|
Facility
IP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.44 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 7 x 80x 40CM
|
Facility
OP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.68 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,402.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,107.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,571.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,898.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,213.78
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,967.00
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,571.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 8.0 x 40x 75cm #3917108047
|
Facility
OP
|
$3,842.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.76 |
| Max. Negotiated Rate |
$3,534.64 |
| Rate for Payer: Aetna Commercial |
$3,457.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,075.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,497.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,921.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,844.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.26
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cigna Commercial |
$3,534.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,149.98
|
| Rate for Payer: Health EOS Commercial |
$3,419.38
|
| Rate for Payer: HFN Commercial |
$3,534.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,881.50
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,534.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,882.58
|
| Rate for Payer: Quartz Commercial |
$2,497.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,305.20
|
| Rate for Payer: WEA Trust Commercial |
$2,113.10
|
| Rate for Payer: WPS Commercial |
$2,845.77
|
|
|
BALLOON MUSTANG 8.0 x 40x 75cm #3917108047
|
Facility
IP
|
$3,842.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,882.58 |
| Max. Negotiated Rate |
$3,534.64 |
| Rate for Payer: Aetna Commercial |
$3,457.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.26
|
| Rate for Payer: Cash Price |
$1,152.60
|
| Rate for Payer: Cigna Commercial |
$3,534.64
|
| Rate for Payer: Health EOS Commercial |
$3,419.38
|
| Rate for Payer: HFN Commercial |
$3,534.64
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,534.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,882.58
|
| Rate for Payer: Quartz Commercial |
$2,305.20
|
| Rate for Payer: WEA Trust Commercial |
$2,113.10
|
| Rate for Payer: WPS Commercial |
$2,845.77
|
|
|
BALLOON MUSTANG 8 x 40x 40CM H74939171080440
|
Facility
OP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.68 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,402.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,107.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,571.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,898.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,213.78
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,967.00
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,571.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 8 x 40x 40CM H74939171080440
|
Facility
IP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.44 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 8 x 80x 40CM
|
Facility
OP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.68 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,402.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,107.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,571.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,898.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,213.78
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,967.00
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,571.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON MUSTANG 8 x 80x 40CM
|
Facility
IP
|
$3,956.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3467514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.44 |
| Max. Negotiated Rate |
$3,639.52 |
| Rate for Payer: Aetna Commercial |
$3,560.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.68
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,639.52
|
| Rate for Payer: Health EOS Commercial |
$3,520.84
|
| Rate for Payer: HFN Commercial |
$3,639.52
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,639.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.44
|
| Rate for Payer: Quartz Commercial |
$2,373.60
|
| Rate for Payer: WEA Trust Commercial |
$2,175.80
|
| Rate for Payer: WPS Commercial |
$2,930.21
|
|
|
BALLOON NANOCROSS 2.0x120x150
|
Facility
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.32 |
| Max. Negotiated Rate |
$3,030.48 |
| Rate for Payer: Aetna Commercial |
$2,964.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,832.84
|
| Rate for Payer: Aetna Managed Medicare |
$922.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,141.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,647.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,581.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.82
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,030.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,843.32
|
| Rate for Payer: Health EOS Commercial |
$2,931.66
|
| Rate for Payer: HFN Commercial |
$3,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,470.50
|
| Rate for Payer: Multiplan Commercial |
$2,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.06
|
| Rate for Payer: Quartz Commercial |
$2,141.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,976.40
|
| Rate for Payer: WEA Trust Commercial |
$1,811.70
|
| Rate for Payer: WPS Commercial |
$2,439.87
|
|
|
BALLOON NANOCROSS 2.0x120x150
|
Facility
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,614.06 |
| Max. Negotiated Rate |
$3,030.48 |
| Rate for Payer: Aetna Commercial |
$2,964.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.82
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,030.48
|
| Rate for Payer: Health EOS Commercial |
$2,931.66
|
| Rate for Payer: HFN Commercial |
$3,030.48
|
| Rate for Payer: Multiplan Commercial |
$2,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.06
|
| Rate for Payer: Quartz Commercial |
$1,976.40
|
| Rate for Payer: WEA Trust Commercial |
$1,811.70
|
| Rate for Payer: WPS Commercial |
$2,439.87
|
|
|
BALLOON NANOCROSS 2.0 x 150mm #AB14W020150150
|
Facility
IP
|
$4,452.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,181.48 |
| Max. Negotiated Rate |
$4,095.84 |
| Rate for Payer: Aetna Commercial |
$4,006.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,359.56
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,095.84
|
| Rate for Payer: Health EOS Commercial |
$3,962.28
|
| Rate for Payer: HFN Commercial |
$4,095.84
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,095.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,181.48
|
| Rate for Payer: Quartz Commercial |
$2,671.20
|
| Rate for Payer: WEA Trust Commercial |
$2,448.60
|
| Rate for Payer: WPS Commercial |
$3,297.60
|
|
|
BALLOON NANOCROSS 2.0 x 150mm #AB14W020150150
|
Facility
OP
|
$4,452.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.56 |
| Max. Negotiated Rate |
$4,095.84 |
| Rate for Payer: Aetna Commercial |
$4,006.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,828.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,893.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,226.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,136.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,359.56
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,095.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,491.34
|
| Rate for Payer: Health EOS Commercial |
$3,962.28
|
| Rate for Payer: HFN Commercial |
$4,095.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,339.00
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,095.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,181.48
|
| Rate for Payer: Quartz Commercial |
$2,893.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,671.20
|
| Rate for Payer: WEA Trust Commercial |
$2,448.60
|
| Rate for Payer: WPS Commercial |
$3,297.60
|
|
|
BALLOON NANOCROSS 2.0 x 40mm X 150
|
Facility
IP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.86 |
| Max. Negotiated Rate |
$3,140.88 |
| Rate for Payer: Aetna Commercial |
$3,072.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.42
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,140.88
|
| Rate for Payer: Health EOS Commercial |
$3,038.46
|
| Rate for Payer: HFN Commercial |
$3,140.88
|
| Rate for Payer: Multiplan Commercial |
$2,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,140.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.86
|
| Rate for Payer: Quartz Commercial |
$2,048.40
|
| Rate for Payer: WEA Trust Commercial |
$1,877.70
|
| Rate for Payer: WPS Commercial |
$2,528.75
|
|
|
BALLOON NANOCROSS 2.0 x 40mm X 150
|
Facility
OP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.92 |
| Max. Negotiated Rate |
$3,140.88 |
| Rate for Payer: Aetna Commercial |
$3,072.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.04
|
| Rate for Payer: Aetna Managed Medicare |
$955.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.42
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,140.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.47
|
| Rate for Payer: Health EOS Commercial |
$3,038.46
|
| Rate for Payer: HFN Commercial |
$3,140.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.50
|
| Rate for Payer: Multiplan Commercial |
$2,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,140.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.86
|
| Rate for Payer: Quartz Commercial |
$2,219.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.40
|
| Rate for Payer: WEA Trust Commercial |
$1,877.70
|
| Rate for Payer: WPS Commercial |
$2,528.75
|
|
|
BALLOON NANOCROSS 2.0 x 80mm
|
Facility
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,614.06 |
| Max. Negotiated Rate |
$3,030.48 |
| Rate for Payer: Aetna Commercial |
$2,964.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.82
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,030.48
|
| Rate for Payer: Health EOS Commercial |
$2,931.66
|
| Rate for Payer: HFN Commercial |
$3,030.48
|
| Rate for Payer: Multiplan Commercial |
$2,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.06
|
| Rate for Payer: Quartz Commercial |
$1,976.40
|
| Rate for Payer: WEA Trust Commercial |
$1,811.70
|
| Rate for Payer: WPS Commercial |
$2,439.87
|
|
|
BALLOON NANOCROSS 2.0 x 80mm
|
Facility
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.32 |
| Max. Negotiated Rate |
$3,030.48 |
| Rate for Payer: Aetna Commercial |
$2,964.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,832.84
|
| Rate for Payer: Aetna Managed Medicare |
$922.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,141.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,647.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,581.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.82
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,030.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,843.32
|
| Rate for Payer: Health EOS Commercial |
$2,931.66
|
| Rate for Payer: HFN Commercial |
$3,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,470.50
|
| Rate for Payer: Multiplan Commercial |
$2,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.06
|
| Rate for Payer: Quartz Commercial |
$2,141.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,976.40
|
| Rate for Payer: WEA Trust Commercial |
$1,811.70
|
| Rate for Payer: WPS Commercial |
$2,439.87
|
|
|
BALLOON NANOCROSS 2.5x120x150
|
Facility
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,614.06 |
| Max. Negotiated Rate |
$3,030.48 |
| Rate for Payer: Aetna Commercial |
$2,964.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.82
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,030.48
|
| Rate for Payer: Health EOS Commercial |
$2,931.66
|
| Rate for Payer: HFN Commercial |
$3,030.48
|
| Rate for Payer: Multiplan Commercial |
$2,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.06
|
| Rate for Payer: Quartz Commercial |
$1,976.40
|
| Rate for Payer: WEA Trust Commercial |
$1,811.70
|
| Rate for Payer: WPS Commercial |
$2,439.87
|
|
|
BALLOON NANOCROSS 2.5x120x150
|
Facility
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.32 |
| Max. Negotiated Rate |
$3,030.48 |
| Rate for Payer: Aetna Commercial |
$2,964.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,832.84
|
| Rate for Payer: Aetna Managed Medicare |
$922.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,141.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,647.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,581.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.82
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,030.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,843.32
|
| Rate for Payer: Health EOS Commercial |
$2,931.66
|
| Rate for Payer: HFN Commercial |
$3,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,470.50
|
| Rate for Payer: Multiplan Commercial |
$2,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.06
|
| Rate for Payer: Quartz Commercial |
$2,141.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,976.40
|
| Rate for Payer: WEA Trust Commercial |
$1,811.70
|
| Rate for Payer: WPS Commercial |
$2,439.87
|
|
|
BALLOON NANOCROSS 2.5 x 150mm
|
Facility
IP
|
$3,538.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.62 |
| Max. Negotiated Rate |
$3,254.96 |
| Rate for Payer: Aetna Commercial |
$3,184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.14
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$3,254.96
|
| Rate for Payer: Health EOS Commercial |
$3,148.82
|
| Rate for Payer: HFN Commercial |
$3,254.96
|
| Rate for Payer: Multiplan Commercial |
$2,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,254.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.62
|
| Rate for Payer: Quartz Commercial |
$2,122.80
|
| Rate for Payer: WEA Trust Commercial |
$1,945.90
|
| Rate for Payer: WPS Commercial |
$2,620.60
|
|
|
BALLOON NANOCROSS 2.5 x 150mm
|
Facility
OP
|
$3,538.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$990.64 |
| Max. Negotiated Rate |
$3,254.96 |
| Rate for Payer: Aetna Commercial |
$3,184.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,042.68
|
| Rate for Payer: Aetna Managed Medicare |
$990.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,299.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,769.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,698.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.14
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$3,254.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,979.86
|
| Rate for Payer: Health EOS Commercial |
$3,148.82
|
| Rate for Payer: HFN Commercial |
$3,254.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,653.50
|
| Rate for Payer: Multiplan Commercial |
$2,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,254.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.62
|
| Rate for Payer: Quartz Commercial |
$2,299.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,122.80
|
| Rate for Payer: WEA Trust Commercial |
$1,945.90
|
| Rate for Payer: WPS Commercial |
$2,620.60
|
|
|
BALLOON NANOCROSS 2.5 x 40mm
|
Facility
IP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.86 |
| Max. Negotiated Rate |
$3,140.88 |
| Rate for Payer: Aetna Commercial |
$3,072.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.42
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,140.88
|
| Rate for Payer: Health EOS Commercial |
$3,038.46
|
| Rate for Payer: HFN Commercial |
$3,140.88
|
| Rate for Payer: Multiplan Commercial |
$2,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,140.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.86
|
| Rate for Payer: Quartz Commercial |
$2,048.40
|
| Rate for Payer: WEA Trust Commercial |
$1,877.70
|
| Rate for Payer: WPS Commercial |
$2,528.75
|
|
|
BALLOON NANOCROSS 2.5 x 40mm
|
Facility
OP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.92 |
| Max. Negotiated Rate |
$3,140.88 |
| Rate for Payer: Aetna Commercial |
$3,072.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.04
|
| Rate for Payer: Aetna Managed Medicare |
$955.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.42
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,140.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.47
|
| Rate for Payer: Health EOS Commercial |
$3,038.46
|
| Rate for Payer: HFN Commercial |
$3,140.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.50
|
| Rate for Payer: Multiplan Commercial |
$2,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,140.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.86
|
| Rate for Payer: Quartz Commercial |
$2,219.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.40
|
| Rate for Payer: WEA Trust Commercial |
$1,877.70
|
| Rate for Payer: WPS Commercial |
$2,528.75
|
|
|
BALLOON NANOCROSS 2.5x80x150
|
Facility
IP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.86 |
| Max. Negotiated Rate |
$3,140.88 |
| Rate for Payer: Aetna Commercial |
$3,072.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.42
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,140.88
|
| Rate for Payer: Health EOS Commercial |
$3,038.46
|
| Rate for Payer: HFN Commercial |
$3,140.88
|
| Rate for Payer: Multiplan Commercial |
$2,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,140.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.86
|
| Rate for Payer: Quartz Commercial |
$2,048.40
|
| Rate for Payer: WEA Trust Commercial |
$1,877.70
|
| Rate for Payer: WPS Commercial |
$2,528.75
|
|
