|
BLADE BEAVER ROUND TIP 376400
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
2965512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$292.00
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
BLADE BEAVER ROUND TIP 376400
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
2965512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
BLADE CLIPPER CARDINAL BLUE 4406
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
2963159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
BLADE CLIPPER CARDINAL BLUE 4406
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
2963159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
BLADE CLIPPER SENSICLIP PINK 4403A
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2965815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
BLADE CLIPPER SENSICLIP PINK 4403A
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2965815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
BLADE CRESCENT STR 8065990001
|
Facility
|
OP
|
$534.00
|
|
| Hospital Charge Code |
2964170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.52 |
| Max. Negotiated Rate |
$2,136.00 |
| Rate for Payer: Aetna Commercial |
$480.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.24
|
| Rate for Payer: Aetna Managed Medicare |
$149.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.02
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$491.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.83
|
| Rate for Payer: Health EOS Commercial |
$475.26
|
| Rate for Payer: HFN Commercial |
$491.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.50
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: NAPHCARE Commercial |
$320.40
|
| Rate for Payer: Preferred Network Access Commercial |
$491.28
|
| Rate for Payer: Quartz Beloit One Network |
$261.66
|
| Rate for Payer: Quartz Commercial |
$347.10
|
| Rate for Payer: Quartz Medicare Advantage |
$320.40
|
| Rate for Payer: The Alliance Commercial |
$2,136.00
|
| Rate for Payer: WEA Trust Commercial |
$293.70
|
| Rate for Payer: WPS Commercial |
$395.53
|
|
|
BLADE CRESCENT STR 8065990001
|
Facility
|
IP
|
$534.00
|
|
| Hospital Charge Code |
2964170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.66 |
| Max. Negotiated Rate |
$491.28 |
| Rate for Payer: Aetna Commercial |
$480.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.02
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$491.28
|
| Rate for Payer: Health EOS Commercial |
$475.26
|
| Rate for Payer: HFN Commercial |
$491.28
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: NAPHCARE Commercial |
$320.40
|
| Rate for Payer: Preferred Network Access Commercial |
$491.28
|
| Rate for Payer: Quartz Beloit One Network |
$261.66
|
| Rate for Payer: Quartz Commercial |
$320.40
|
| Rate for Payer: WEA Trust Commercial |
$293.70
|
| Rate for Payer: WPS Commercial |
$395.53
|
|
|
BLADE DERMATOME 8800-000-10
|
Facility
|
OP
|
$748.00
|
|
| Hospital Charge Code |
2967410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$2,992.00 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.58
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$486.20
|
| Rate for Payer: Quartz Medicare Advantage |
$448.80
|
| Rate for Payer: The Alliance Commercial |
$2,992.00
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
BLADE DERMATOME 8800-000-10
|
Facility
|
IP
|
$748.00
|
|
| Hospital Charge Code |
2967410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$688.16 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$448.80
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
BLADE DISP MCGRATH SNGL USE #550-008-000
|
Facility
|
OP
|
$484.00
|
|
| Hospital Charge Code |
2973713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
BLADE DISP MCGRATH SNGL USE #550-008-000
|
Facility
|
IP
|
$484.00
|
|
| Hospital Charge Code |
2973713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
BLADE EXPLANT 52MM LONG(FULL)
|
Facility
|
OP
|
$6,407.00
|
|
| Hospital Charge Code |
2967449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,793.96 |
| Max. Negotiated Rate |
$25,628.00 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,510.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,164.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,075.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,585.36
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,805.25
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$4,164.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,844.20
|
| Rate for Payer: The Alliance Commercial |
$25,628.00
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
|
BLADE EXPLANT 52MM LONG(FULL)
|
Facility
|
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2967449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,139.43 |
| Max. Negotiated Rate |
$5,894.44 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,510.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$3,844.20
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
|
BLADE GIGLI 2808-100
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2967411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
BLADE GIGLI 2808-100
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2967411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
BLADE GVL 3 STAT
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
2963832
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
BLADE GVL 3 STAT
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
2963832
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$97.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.74
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$208.80
|
| Rate for Payer: The Alliance Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
BLADE GVL 4 STAT
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
2963836
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$97.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.74
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$208.80
|
| Rate for Payer: The Alliance Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
BLADE GVL 4 STAT
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
2963836
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
BLADE HEAVY DUTY SAGITTAL FAN OFFSET 2108-107-4
|
Facility
|
OP
|
$818.00
|
|
| Hospital Charge Code |
4519118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.04 |
| Max. Negotiated Rate |
$3,272.00 |
| Rate for Payer: Aetna Commercial |
$736.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.48
|
| Rate for Payer: Aetna Managed Medicare |
$229.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.54
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$752.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.75
|
| Rate for Payer: Health EOS Commercial |
$728.02
|
| Rate for Payer: HFN Commercial |
$752.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.50
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: NAPHCARE Commercial |
$490.80
|
| Rate for Payer: Preferred Network Access Commercial |
$752.56
|
| Rate for Payer: Quartz Beloit One Network |
$400.82
|
| Rate for Payer: Quartz Commercial |
$531.70
|
| Rate for Payer: Quartz Medicare Advantage |
$490.80
|
| Rate for Payer: The Alliance Commercial |
$3,272.00
|
| Rate for Payer: WEA Trust Commercial |
$449.90
|
| Rate for Payer: WPS Commercial |
$605.89
|
|
|
BLADE HEAVY DUTY SAGITTAL FAN OFFSET 2108-107-4
|
Facility
|
IP
|
$818.00
|
|
| Hospital Charge Code |
4519118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.82 |
| Max. Negotiated Rate |
$752.56 |
| Rate for Payer: Aetna Commercial |
$736.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.54
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$752.56
|
| Rate for Payer: Health EOS Commercial |
$728.02
|
| Rate for Payer: HFN Commercial |
$752.56
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: NAPHCARE Commercial |
$490.80
|
| Rate for Payer: Preferred Network Access Commercial |
$752.56
|
| Rate for Payer: Quartz Beloit One Network |
$400.82
|
| Rate for Payer: Quartz Commercial |
$490.80
|
| Rate for Payer: WEA Trust Commercial |
$449.90
|
| Rate for Payer: WPS Commercial |
$605.89
|
|
|
BLADE HELICAL TFN 11.0 100MM 456.305S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,634.73 |
| Max. Negotiated Rate |
$4,946.84 |
| Rate for Payer: Aetna Commercial |
$4,839.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,849.81
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$4,946.84
|
| Rate for Payer: Health EOS Commercial |
$4,785.53
|
| Rate for Payer: HFN Commercial |
$4,946.84
|
| Rate for Payer: Multiplan Commercial |
$4,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,946.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,634.73
|
| Rate for Payer: Quartz Commercial |
$3,226.20
|
| Rate for Payer: WEA Trust Commercial |
$2,957.35
|
| Rate for Payer: WPS Commercial |
$3,982.74
|
|
|
BLADE HELICAL TFN 11.0 100MM 456.305S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.56 |
| Max. Negotiated Rate |
$21,508.00 |
| Rate for Payer: Aetna Commercial |
$4,839.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,505.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,495.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,580.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,849.81
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$4,946.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,008.97
|
| Rate for Payer: Health EOS Commercial |
$4,785.53
|
| Rate for Payer: HFN Commercial |
$4,946.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,032.75
|
| Rate for Payer: Multiplan Commercial |
$4,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,946.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,634.73
|
| Rate for Payer: Quartz Commercial |
$3,495.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,226.20
|
| Rate for Payer: The Alliance Commercial |
$21,508.00
|
| Rate for Payer: WEA Trust Commercial |
$2,957.35
|
| Rate for Payer: WPS Commercial |
$3,982.74
|
|
|
BLADE HELICAL TFN 11.0 105MM 456.306S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.56 |
| Max. Negotiated Rate |
$21,508.00 |
| Rate for Payer: Aetna Commercial |
$4,839.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,505.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,495.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,580.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,849.81
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$4,946.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,008.97
|
| Rate for Payer: Health EOS Commercial |
$4,785.53
|
| Rate for Payer: HFN Commercial |
$4,946.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,032.75
|
| Rate for Payer: Multiplan Commercial |
$4,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,946.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,634.73
|
| Rate for Payer: Quartz Commercial |
$3,495.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,226.20
|
| Rate for Payer: The Alliance Commercial |
$21,508.00
|
| Rate for Payer: WEA Trust Commercial |
$2,957.35
|
| Rate for Payer: WPS Commercial |
$3,982.74
|
|
