|
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 |
$1,565.78 |
| 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 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 |
$2,814.01 |
| Max. Negotiated Rate |
$5,283.45 |
| Rate for Payer: Aetna Commercial |
$5,168.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,938.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,043.73
|
| Rate for Payer: Cash Price |
$1,656.60
|
| Rate for Payer: Cigna Commercial |
$5,283.45
|
| Rate for Payer: Health EOS Commercial |
$5,111.16
|
| Rate for Payer: HFN Commercial |
$5,283.45
|
| Rate for Payer: Multiplan Commercial |
$4,594.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,283.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.01
|
| Rate for Payer: Quartz Commercial |
$3,445.73
|
| Rate for Payer: WEA Trust Commercial |
$3,158.58
|
| Rate for Payer: WPS Commercial |
$4,253.60
|
|
|
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 |
$1,608.01 |
| Max. Negotiated Rate |
$5,283.45 |
| Rate for Payer: Aetna Commercial |
$5,168.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,938.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,608.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,732.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,756.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,043.73
|
| Rate for Payer: Cash Price |
$1,656.60
|
| Rate for Payer: Cigna Commercial |
$5,283.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,213.80
|
| Rate for Payer: Health EOS Commercial |
$5,111.16
|
| Rate for Payer: HFN Commercial |
$5,283.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,307.16
|
| Rate for Payer: Multiplan Commercial |
$4,594.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,445.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,283.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.01
|
| Rate for Payer: Quartz Commercial |
$3,732.87
|
| Rate for Payer: Quartz Medicare Advantage |
$3,445.73
|
| Rate for Payer: The Alliance Commercial |
$2,871.44
|
| Rate for Payer: WEA Trust Commercial |
$3,158.58
|
| Rate for Payer: WPS Commercial |
$4,253.60
|
|
|
BLADE HELIX DHHS SYNTHES
|
Facility
|
IP
|
$4,591.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.57 |
| Max. Negotiated Rate |
$4,392.67 |
| Rate for Payer: Aetna Commercial |
$4,297.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,106.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,530.56
|
| Rate for Payer: Cash Price |
$1,377.30
|
| Rate for Payer: Cigna Commercial |
$4,392.67
|
| Rate for Payer: Health EOS Commercial |
$4,249.43
|
| Rate for Payer: HFN Commercial |
$4,392.67
|
| Rate for Payer: Multiplan Commercial |
$3,819.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,392.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,339.57
|
| Rate for Payer: Quartz Commercial |
$2,864.78
|
| Rate for Payer: WEA Trust Commercial |
$2,626.05
|
| Rate for Payer: WPS Commercial |
$3,536.45
|
|
|
BLADE HELIX DHHS SYNTHES
|
Facility
|
OP
|
$4,591.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.90 |
| Max. Negotiated Rate |
$4,392.67 |
| Rate for Payer: Aetna Commercial |
$4,297.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,106.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,336.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,103.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,387.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,291.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,530.56
|
| Rate for Payer: Cash Price |
$1,377.30
|
| Rate for Payer: Cigna Commercial |
$4,392.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,671.96
|
| Rate for Payer: Health EOS Commercial |
$4,249.43
|
| Rate for Payer: HFN Commercial |
$4,392.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,580.98
|
| Rate for Payer: Multiplan Commercial |
$3,819.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,864.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,392.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,339.57
|
| Rate for Payer: Quartz Commercial |
$3,103.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,864.78
|
| Rate for Payer: The Alliance Commercial |
$2,387.32
|
| Rate for Payer: WEA Trust Commercial |
$2,626.05
|
| Rate for Payer: WPS Commercial |
$3,536.45
|
|
|
BLADE KDB GLIDE 10-0065
|
Facility
|
OP
|
$4,868.00
|
|
| Hospital Charge Code |
6173256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,417.56 |
| Max. Negotiated Rate |
$4,657.70 |
| Rate for Payer: Aetna Commercial |
$4,556.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,353.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,417.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,290.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,531.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,430.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.24
|
| Rate for Payer: Cash Price |
$1,460.40
|
| Rate for Payer: Cigna Commercial |
$4,657.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.18
|
| Rate for Payer: Health EOS Commercial |
$4,505.82
|
| Rate for Payer: HFN Commercial |
$4,657.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,797.04
|
| Rate for Payer: Multiplan Commercial |
$4,050.18
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.63
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.73
|
| Rate for Payer: Quartz Commercial |
$3,290.77
|
| Rate for Payer: Quartz Medicare Advantage |
$3,037.63
|
| Rate for Payer: The Alliance Commercial |
$2,531.36
|
| Rate for Payer: WEA Trust Commercial |
$2,784.50
|
| Rate for Payer: WPS Commercial |
$3,749.82
|
|
|
BLADE KDB GLIDE 10-0065
|
Facility
|
IP
|
$4,868.00
|
|
| Hospital Charge Code |
6173256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,480.73 |
| Max. Negotiated Rate |
$4,657.70 |
| Rate for Payer: Aetna Commercial |
$4,556.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,353.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.24
|
| Rate for Payer: Cash Price |
$1,460.40
|
| Rate for Payer: Cigna Commercial |
$4,657.70
|
| Rate for Payer: Health EOS Commercial |
$4,505.82
|
| Rate for Payer: HFN Commercial |
$4,657.70
|
| Rate for Payer: Multiplan Commercial |
$4,050.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.73
|
| Rate for Payer: Quartz Commercial |
$3,037.63
|
| Rate for Payer: WEA Trust Commercial |
$2,784.50
|
| Rate for Payer: WPS Commercial |
$3,749.82
|
|
|
BLADE KURZ CARTILAGE KNIFE 8000 140
|
Facility
|
OP
|
$334.00
|
|
| Hospital Charge Code |
3157482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.26 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$97.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.52
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$208.42
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$208.42
|
| Rate for Payer: The Alliance Commercial |
$173.68
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
BLADE KURZ CARTILAGE KNIFE 8000 140
|
Facility
|
IP
|
$334.00
|
|
| Hospital Charge Code |
3157482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
BLADE LARYNG MAC 2 POLARIS 4150120
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963289
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MAC 2 POLARIS 4150120
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2963289
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MAC 3 POLARIS 4150130
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
2963288
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
BLADE LARYNG MAC 3 POLARIS 4150130
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
2963288
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
BLADE LARYNG MAC 4 POLARIS 4150140
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
2963287
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
BLADE LARYNG MAC 4 POLARIS 4150140
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
2963287
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
BLADE LARYNG MILLER 1 POLARIS 4150010
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2963291
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MILLER 1 POLARIS 4150010
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963291
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MILLER 2 POLARIS 4150020
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MILLER 2 POLARIS 4150020
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2963292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MILLER 3 POLARIS 4150030
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2963290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LARYNG MILLER 3 POLARIS 4150030
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE LONG MEDIUM 25.0 2296-033-111
|
Facility
|
OP
|
$760.00
|
|
| Hospital Charge Code |
2966098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$221.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$474.24
|
| Rate for Payer: The Alliance Commercial |
$395.20
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE LONG MEDIUM 25.0 2296-033-111
|
Facility
|
IP
|
$760.00
|
|
| Hospital Charge Code |
2966098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE LONG NARROW 2296-003-414
|
Facility
|
IP
|
$760.00
|
|
| Hospital Charge Code |
2966099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE LONG NARROW 2296-003-414
|
Facility
|
OP
|
$760.00
|
|
| Hospital Charge Code |
2966099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$221.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$474.24
|
| Rate for Payer: The Alliance Commercial |
$395.20
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
