|
BLADE GIGLI 2808-100
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2967411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
BLADE GIGLI 2808-100
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2967411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
BLADE GVL 3 STAT
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
2963832
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$101.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.44
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$217.15
|
| Rate for Payer: The Alliance Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
BLADE GVL 3 STAT
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
2963832
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
BLADE GVL 4 STAT
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
2963836
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
BLADE GVL 4 STAT
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
2963836
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$101.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.44
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$217.15
|
| Rate for Payer: The Alliance Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
BLADE HEAVY DUTY SAGITTAL FAN OFFSET 2108-107-4
|
Facility
|
OP
|
$818.00
|
|
| Hospital Charge Code |
4519118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$782.66 |
| Rate for Payer: Aetna Commercial |
$765.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.62
|
| Rate for Payer: Aetna Managed Medicare |
$238.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.88
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$782.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.08
|
| Rate for Payer: Health EOS Commercial |
$757.14
|
| Rate for Payer: HFN Commercial |
$782.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.04
|
| Rate for Payer: Multiplan Commercial |
$680.58
|
| Rate for Payer: NAPHCARE Commercial |
$510.43
|
| Rate for Payer: Preferred Network Access Commercial |
$782.66
|
| Rate for Payer: Quartz Beloit One Network |
$416.85
|
| Rate for Payer: Quartz Commercial |
$552.97
|
| Rate for Payer: Quartz Medicare Advantage |
$510.43
|
| Rate for Payer: The Alliance Commercial |
$425.36
|
| Rate for Payer: WEA Trust Commercial |
$467.90
|
| Rate for Payer: WPS Commercial |
$630.11
|
|
|
BLADE HEAVY DUTY SAGITTAL FAN OFFSET 2108-107-4
|
Facility
|
IP
|
$818.00
|
|
| Hospital Charge Code |
4519118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.85 |
| Max. Negotiated Rate |
$782.66 |
| Rate for Payer: Aetna Commercial |
$765.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.88
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$782.66
|
| Rate for Payer: Health EOS Commercial |
$757.14
|
| Rate for Payer: HFN Commercial |
$782.66
|
| Rate for Payer: Multiplan Commercial |
$680.58
|
| Rate for Payer: Preferred Network Access Commercial |
$782.66
|
| Rate for Payer: Quartz Beloit One Network |
$416.85
|
| Rate for Payer: Quartz Commercial |
$510.43
|
| Rate for Payer: WEA Trust Commercial |
$467.90
|
| Rate for Payer: WPS Commercial |
$630.11
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$3,098.95 |
| Max. Negotiated Rate |
$10,182.27 |
| Rate for Payer: Aetna Commercial |
$9,960.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,518.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,098.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,193.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,533.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,312.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,865.87
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$10,182.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,193.64
|
| Rate for Payer: Health EOS Commercial |
$9,850.24
|
| Rate for Payer: HFN Commercial |
$10,182.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,300.76
|
| Rate for Payer: Multiplan Commercial |
$8,854.14
|
| Rate for Payer: NAPHCARE Commercial |
$6,640.61
|
| Rate for Payer: Preferred Network Access Commercial |
$10,182.27
|
| Rate for Payer: Quartz Beloit One Network |
$5,423.16
|
| Rate for Payer: Quartz Commercial |
$7,193.99
|
| Rate for Payer: Quartz Medicare Advantage |
$6,640.61
|
| Rate for Payer: The Alliance Commercial |
$5,533.84
|
| Rate for Payer: WEA Trust Commercial |
$6,087.22
|
| Rate for Payer: WPS Commercial |
$8,197.53
|
|
|
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 |
$5,423.16 |
| Max. Negotiated Rate |
$10,182.27 |
| Rate for Payer: Aetna Commercial |
$9,960.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,518.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,865.87
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$10,182.27
|
| Rate for Payer: Health EOS Commercial |
$9,850.24
|
| Rate for Payer: HFN Commercial |
$10,182.27
|
| Rate for Payer: Multiplan Commercial |
$8,854.14
|
| Rate for Payer: Preferred Network Access Commercial |
$10,182.27
|
| Rate for Payer: Quartz Beloit One Network |
$5,423.16
|
| Rate for Payer: Quartz Commercial |
$6,640.61
|
| Rate for Payer: WEA Trust Commercial |
$6,087.22
|
| Rate for Payer: WPS Commercial |
$8,197.53
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$1,565.78 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.41
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.06
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,634.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.25
|
| Rate for Payer: The Alliance Commercial |
$2,796.04
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
|
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 |
$2,740.12 |
| Max. Negotiated Rate |
$5,144.71 |
| Rate for Payer: Aetna Commercial |
$5,032.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.80
|
| Rate for Payer: Cash Price |
$1,613.10
|
| Rate for Payer: Cigna Commercial |
$5,144.71
|
| Rate for Payer: Health EOS Commercial |
$4,976.95
|
| Rate for Payer: HFN Commercial |
$5,144.71
|
| Rate for Payer: Multiplan Commercial |
$4,473.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.12
|
| Rate for Payer: Quartz Commercial |
$3,355.25
|
| Rate for Payer: WEA Trust Commercial |
$3,075.64
|
| Rate for Payer: WPS Commercial |
$4,141.90
|
|
