|
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 |
$2,015.98 |
| Max. Negotiated Rate |
$3,785.10 |
| Rate for Payer: Aetna Commercial |
$3,702.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,538.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,180.55
|
| Rate for Payer: Cash Price |
$1,186.80
|
| Rate for Payer: Cigna Commercial |
$3,785.10
|
| Rate for Payer: Health EOS Commercial |
$3,661.67
|
| Rate for Payer: HFN Commercial |
$3,785.10
|
| Rate for Payer: Multiplan Commercial |
$3,291.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,785.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,015.98
|
| Rate for Payer: Quartz Commercial |
$2,468.54
|
| Rate for Payer: WEA Trust Commercial |
$2,262.83
|
| Rate for Payer: WPS Commercial |
$3,047.31
|
|
|
BALLOON NANOCROSS 2.0x120x150
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.21 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Aetna Managed Medicare |
$959.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,226.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,917.11
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.32
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,055.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,226.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.46
|
| Rate for Payer: The Alliance Commercial |
$1,712.88
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 2.0x120x150
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,678.62 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,055.46
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
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 |
$2,268.74 |
| Max. Negotiated Rate |
$4,259.67 |
| Rate for Payer: Aetna Commercial |
$4,167.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,981.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,453.94
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,259.67
|
| Rate for Payer: Health EOS Commercial |
$4,120.77
|
| Rate for Payer: HFN Commercial |
$4,259.67
|
| Rate for Payer: Multiplan Commercial |
$3,704.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,259.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,268.74
|
| Rate for Payer: Quartz Commercial |
$2,778.05
|
| Rate for Payer: WEA Trust Commercial |
$2,546.54
|
| Rate for Payer: WPS Commercial |
$3,429.38
|
|
|
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 |
$1,296.42 |
| Max. Negotiated Rate |
$4,259.67 |
| Rate for Payer: Aetna Commercial |
$4,167.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,981.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,296.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,009.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,315.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,222.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,453.94
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,259.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,591.06
|
| Rate for Payer: Health EOS Commercial |
$4,120.77
|
| Rate for Payer: HFN Commercial |
$4,259.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,472.56
|
| Rate for Payer: Multiplan Commercial |
$3,704.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,778.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,259.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,268.74
|
| Rate for Payer: Quartz Commercial |
$3,009.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,778.05
|
| Rate for Payer: The Alliance Commercial |
$2,315.04
|
| Rate for Payer: WEA Trust Commercial |
$2,546.54
|
| Rate for Payer: WPS Commercial |
$3,429.38
|
|
|
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 |
$1,739.77 |
| Max. Negotiated Rate |
$3,266.52 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,053.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,266.52
|
| Rate for Payer: Health EOS Commercial |
$3,160.00
|
| Rate for Payer: HFN Commercial |
$3,266.52
|
| Rate for Payer: Multiplan Commercial |
$2,840.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,266.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.77
|
| Rate for Payer: Quartz Commercial |
$2,130.34
|
| Rate for Payer: WEA Trust Commercial |
$1,952.81
|
| Rate for Payer: WPS Commercial |
$2,629.80
|
|
|
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 |
$994.16 |
| Max. Negotiated Rate |
$3,266.52 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,053.48
|
| Rate for Payer: Aetna Managed Medicare |
$994.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,307.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,775.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,266.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,986.95
|
| Rate for Payer: Health EOS Commercial |
$3,160.00
|
| Rate for Payer: HFN Commercial |
$3,266.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,662.92
|
| Rate for Payer: Multiplan Commercial |
$2,840.45
|
| Rate for Payer: NAPHCARE Commercial |
$2,130.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,266.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.77
|
| Rate for Payer: Quartz Commercial |
$2,307.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,130.34
|
| Rate for Payer: The Alliance Commercial |
$1,775.28
|
| Rate for Payer: WEA Trust Commercial |
$1,952.81
|
| Rate for Payer: WPS Commercial |
$2,629.80
|
|
|
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 |
$959.21 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Aetna Managed Medicare |
$959.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,226.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,917.11
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.32
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,055.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,226.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.46
|
| Rate for Payer: The Alliance Commercial |
$1,712.88
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
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 |
$1,678.62 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,055.46
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 2.5x120x150
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.21 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Aetna Managed Medicare |
$959.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,226.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,917.11
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.32
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,055.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,226.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.46
|
| Rate for Payer: The Alliance Commercial |
$1,712.88
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 2.5x120x150
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,678.62 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,055.46
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
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 |
$1,030.27 |
| Max. Negotiated Rate |
$3,385.16 |
| Rate for Payer: Aetna Commercial |
$3,311.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,164.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,030.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,391.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,839.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,766.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.15
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$3,385.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,059.12
|
| Rate for Payer: Health EOS Commercial |
$3,274.77
|
| Rate for Payer: HFN Commercial |
$3,385.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,759.64
|
| Rate for Payer: Multiplan Commercial |
$2,943.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,207.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,385.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,802.96
|
| Rate for Payer: Quartz Commercial |
$2,391.69
|
| Rate for Payer: Quartz Medicare Advantage |
$2,207.71
|
| Rate for Payer: The Alliance Commercial |
$1,839.76
|
| Rate for Payer: WEA Trust Commercial |
$2,023.74
|
| Rate for Payer: WPS Commercial |
$2,725.32
|
|
|
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 |
$1,802.96 |
| Max. Negotiated Rate |
$3,385.16 |
| Rate for Payer: Aetna Commercial |
$3,311.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,164.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.15
|
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$3,385.16
|
| Rate for Payer: Health EOS Commercial |
$3,274.77
|
| Rate for Payer: HFN Commercial |
$3,385.16
|
| Rate for Payer: Multiplan Commercial |
$2,943.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,385.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,802.96
|
| Rate for Payer: Quartz Commercial |
$2,207.71
|
| Rate for Payer: WEA Trust Commercial |
$2,023.74
|
| Rate for Payer: WPS Commercial |
$2,725.32
|
|
|
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 |
$1,739.77 |
| Max. Negotiated Rate |
$3,266.52 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,053.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,266.52
|
| Rate for Payer: Health EOS Commercial |
$3,160.00
|
| Rate for Payer: HFN Commercial |
$3,266.52
|
| Rate for Payer: Multiplan Commercial |
$2,840.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,266.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.77
|
| Rate for Payer: Quartz Commercial |
$2,130.34
|
| Rate for Payer: WEA Trust Commercial |
$1,952.81
|
| Rate for Payer: WPS Commercial |
$2,629.80
|
|
|
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 |
$994.16 |
| Max. Negotiated Rate |
$3,266.52 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,053.48
|
| Rate for Payer: Aetna Managed Medicare |
$994.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,307.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,775.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,266.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,986.95
|
| Rate for Payer: Health EOS Commercial |
$3,160.00
|
| Rate for Payer: HFN Commercial |
$3,266.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,662.92
|
| Rate for Payer: Multiplan Commercial |
$2,840.45
|
| Rate for Payer: NAPHCARE Commercial |
$2,130.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,266.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.77
|
| Rate for Payer: Quartz Commercial |
$2,307.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,130.34
|
| Rate for Payer: The Alliance Commercial |
$1,775.28
|
| Rate for Payer: WEA Trust Commercial |
$1,952.81
|
| Rate for Payer: WPS Commercial |
$2,629.80
|
|
|
BALLOON NANOCROSS 2.5x80x150
|
Facility
|
OP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.16 |
| Max. Negotiated Rate |
$3,266.52 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,053.48
|
| Rate for Payer: Aetna Managed Medicare |
$994.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,307.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,775.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,266.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,986.95
|
| Rate for Payer: Health EOS Commercial |
$3,160.00
|
| Rate for Payer: HFN Commercial |
$3,266.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,662.92
|
| Rate for Payer: Multiplan Commercial |
$2,840.45
|
| Rate for Payer: NAPHCARE Commercial |
$2,130.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,266.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.77
|
| Rate for Payer: Quartz Commercial |
$2,307.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,130.34
|
| Rate for Payer: The Alliance Commercial |
$1,775.28
|
| Rate for Payer: WEA Trust Commercial |
$1,952.81
|
| Rate for Payer: WPS Commercial |
$2,629.80
|
|
|
BALLOON NANOCROSS 2.5x80x150
|
Facility
|
IP
|
$3,414.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,739.77 |
| Max. Negotiated Rate |
$3,266.52 |
| Rate for Payer: Aetna Commercial |
$3,195.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,053.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.80
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$3,266.52
|
| Rate for Payer: Health EOS Commercial |
$3,160.00
|
| Rate for Payer: HFN Commercial |
$3,266.52
|
| Rate for Payer: Multiplan Commercial |
$2,840.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,266.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.77
|
| Rate for Payer: Quartz Commercial |
$2,130.34
|
| Rate for Payer: WEA Trust Commercial |
$1,952.81
|
| Rate for Payer: WPS Commercial |
$2,629.80
|
|
|
BALLOON NANOCROSS 3.0X40mmX150
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,678.62 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,055.46
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 3.0X40mmX150
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.21 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Aetna Managed Medicare |
$959.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,226.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,917.11
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.32
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,055.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,226.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.46
|
| Rate for Payer: The Alliance Commercial |
$1,712.88
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 3.0X80mmX150
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.21 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Aetna Managed Medicare |
$959.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,226.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,917.11
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.32
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,055.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,226.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.46
|
| Rate for Payer: The Alliance Commercial |
$1,712.88
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 3.0X80mmX150
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,678.62 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,055.46
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 3 X120mmX150
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.21 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Aetna Managed Medicare |
$959.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,226.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,917.11
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.32
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,055.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,226.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.46
|
| Rate for Payer: The Alliance Commercial |
$1,712.88
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NANOCROSS 3 X120mmX150
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,678.62 |
| Max. Negotiated Rate |
$3,151.70 |
| Rate for Payer: Aetna Commercial |
$3,083.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,946.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,815.65
|
| Rate for Payer: Cash Price |
$988.20
|
| Rate for Payer: Cigna Commercial |
$3,151.70
|
| Rate for Payer: Health EOS Commercial |
$3,048.93
|
| Rate for Payer: HFN Commercial |
$3,151.70
|
| Rate for Payer: Multiplan Commercial |
$2,740.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,678.62
|
| Rate for Payer: Quartz Commercial |
$2,055.46
|
| Rate for Payer: WEA Trust Commercial |
$1,884.17
|
| Rate for Payer: WPS Commercial |
$2,537.37
|
|
|
BALLOON NC TREK 2.0 X 12MM 1012445-12
|
Facility
|
OP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645498
|
|
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 2.0 X 12MM 1012445-12
|
Facility
|
IP
|
$3,657.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3645498
|
|
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
|
|
