|
BLADE HELICAL TFN 11.0 105MM 456.306S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966599
|
|
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 110MM 456.307S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966600
|
|
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 110MM 456.307S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966600
|
|
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 115MM 456.308S
|
Facility
|
IP
|
$10,642.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,214.58 |
| Max. Negotiated Rate |
$9,790.64 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,385.20
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
|
BLADE HELICAL TFN 11.0 115MM 456.308S
|
Facility
|
OP
|
$10,642.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.76 |
| Max. Negotiated Rate |
$42,568.00 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,979.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,917.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,108.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,955.26
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,981.50
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,917.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,385.20
|
| Rate for Payer: The Alliance Commercial |
$42,568.00
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
|
BLADE HELICAL TFN 11.0 120MM 456.309S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966602
|
|
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 120MM 456.309S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966602
|
|
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 80MM 456.301S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966603
|
|
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 80MM 456.301S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966603
|
|
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 85MM 456.302S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966604
|
|
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 85MM 456.302S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966604
|
|
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 90MM 456.303S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966605
|
|
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 90MM 456.303S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966605
|
|
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 95MM 456.304S
|
Facility
|
IP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966606
|
|
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 95MM 456.304S
|
Facility
|
OP
|
$5,377.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966606
|
|
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 TFNA 90MM 04.038.290S
|
Facility
|
OP
|
$5,522.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,546.16 |
| Max. Negotiated Rate |
$22,088.00 |
| Rate for Payer: Aetna Commercial |
$4,969.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,748.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,546.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,589.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,761.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,650.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,926.66
|
| Rate for Payer: Cash Price |
$1,656.60
|
| Rate for Payer: Cigna Commercial |
$5,080.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,090.11
|
| Rate for Payer: Health EOS Commercial |
$4,914.58
|
| Rate for Payer: HFN Commercial |
$5,080.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,141.50
|
| Rate for Payer: Multiplan Commercial |
$4,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,080.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,705.78
|
| Rate for Payer: Quartz Commercial |
$3,589.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,313.20
|
| Rate for Payer: The Alliance Commercial |
$22,088.00
|
| Rate for Payer: WEA Trust Commercial |
$3,037.10
|
| Rate for Payer: WPS Commercial |
$4,090.15
|
|
|
BLADE HELICAL TFNA 90MM 04.038.290S
|
Facility
|
IP
|
$5,522.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,705.78 |
| Max. Negotiated Rate |
$5,080.24 |
| Rate for Payer: Aetna Commercial |
$4,969.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,748.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,926.66
|
| Rate for Payer: Cash Price |
$1,656.60
|
| Rate for Payer: Cigna Commercial |
$5,080.24
|
| Rate for Payer: Health EOS Commercial |
$4,914.58
|
| Rate for Payer: HFN Commercial |
$5,080.24
|
| Rate for Payer: Multiplan Commercial |
$4,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,080.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,705.78
|
| Rate for Payer: Quartz Commercial |
$3,313.20
|
| Rate for Payer: WEA Trust Commercial |
$3,037.10
|
| Rate for Payer: WPS Commercial |
$4,090.15
|
|
|
BLADE HELIX DHHS SYNTHES
|
Facility
|
IP
|
$4,591.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,249.59 |
| Max. Negotiated Rate |
$4,223.72 |
| Rate for Payer: Aetna Commercial |
$4,131.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,948.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,433.23
|
| Rate for Payer: Cash Price |
$1,377.30
|
| Rate for Payer: Cigna Commercial |
$4,223.72
|
| Rate for Payer: Health EOS Commercial |
$4,085.99
|
| Rate for Payer: HFN Commercial |
$4,223.72
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,754.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,223.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,249.59
|
| Rate for Payer: Quartz Commercial |
$2,754.60
|
| Rate for Payer: WEA Trust Commercial |
$2,525.05
|
| Rate for Payer: WPS Commercial |
$3,400.55
|
|
|
BLADE HELIX DHHS SYNTHES
|
Facility
|
OP
|
$4,591.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.48 |
| Max. Negotiated Rate |
$18,364.00 |
| Rate for Payer: Aetna Commercial |
$4,131.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,948.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,285.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,984.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,203.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,433.23
|
| Rate for Payer: Cash Price |
$1,377.30
|
| Rate for Payer: Cigna Commercial |
$4,223.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,569.12
|
| Rate for Payer: Health EOS Commercial |
$4,085.99
|
| Rate for Payer: HFN Commercial |
$4,223.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,443.25
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,754.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,223.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,249.59
|
| Rate for Payer: Quartz Commercial |
$2,984.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,754.60
|
| Rate for Payer: The Alliance Commercial |
$18,364.00
|
| Rate for Payer: WEA Trust Commercial |
$2,525.05
|
| Rate for Payer: WPS Commercial |
$3,400.55
|
|
|
BLADE KDB GLIDE 10-0065
|
Facility
|
OP
|
$4,868.00
|
|
| Hospital Charge Code |
6173256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,363.04 |
| Max. Negotiated Rate |
$19,472.00 |
| Rate for Payer: Aetna Commercial |
$4,381.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,186.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,363.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,164.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,336.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,580.04
|
| Rate for Payer: Cash Price |
$1,460.40
|
| Rate for Payer: Cigna Commercial |
$4,478.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,724.13
|
| Rate for Payer: Health EOS Commercial |
$4,332.52
|
| Rate for Payer: HFN Commercial |
$4,478.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,651.00
|
| Rate for Payer: Multiplan Commercial |
$3,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,920.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,385.32
|
| Rate for Payer: Quartz Commercial |
$3,164.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,920.80
|
| Rate for Payer: The Alliance Commercial |
$19,472.00
|
| Rate for Payer: WEA Trust Commercial |
$2,677.40
|
| Rate for Payer: WPS Commercial |
$3,605.73
|
|
|
BLADE KDB GLIDE 10-0065
|
Facility
|
IP
|
$4,868.00
|
|
| Hospital Charge Code |
6173256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,385.32 |
| Max. Negotiated Rate |
$4,478.56 |
| Rate for Payer: Aetna Commercial |
$4,381.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,186.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,580.04
|
| Rate for Payer: Cash Price |
$1,460.40
|
| Rate for Payer: Cigna Commercial |
$4,478.56
|
| Rate for Payer: Health EOS Commercial |
$4,332.52
|
| Rate for Payer: HFN Commercial |
$4,478.56
|
| Rate for Payer: Multiplan Commercial |
$3,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,920.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,385.32
|
| Rate for Payer: Quartz Commercial |
$2,920.80
|
| Rate for Payer: WEA Trust Commercial |
$2,677.40
|
| Rate for Payer: WPS Commercial |
$3,605.73
|
|
|
BLADE KURZ CARTILAGE KNIFE 8000 140
|
Facility
|
IP
|
$334.00
|
|
| Hospital Charge Code |
3157482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
BLADE KURZ CARTILAGE KNIFE 8000 140
|
Facility
|
OP
|
$334.00
|
|
| Hospital Charge Code |
3157482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.52 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.40
|
| Rate for Payer: The Alliance Commercial |
$1,336.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
BLADE LARYNG MAC 2 POLARIS 4150120
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963289
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
BLADE LARYNG MAC 2 POLARIS 4150120
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2963289
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
