|
BLADE 15.0 CRESCENT
|
Facility
OP
|
$1,575.00
|
|
| Hospital Charge Code |
2966137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$6,300.00 |
| Rate for Payer: Aetna Commercial |
$1,417.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.50
|
| Rate for Payer: Aetna Managed Medicare |
$441.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.75
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.37
|
| Rate for Payer: Health EOS Commercial |
$1,401.75
|
| Rate for Payer: HFN Commercial |
$1,449.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$945.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.00
|
| Rate for Payer: Quartz Beloit One Network |
$771.75
|
| Rate for Payer: Quartz Commercial |
$1,023.75
|
| Rate for Payer: Quartz Medicare Advantage |
$945.00
|
| Rate for Payer: The Alliance Commercial |
$6,300.00
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
BLADE 15.0 CRESCENT
|
Facility
IP
|
$1,575.00
|
|
| Hospital Charge Code |
2966137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$771.75 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$1,417.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.75
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,449.00
|
| Rate for Payer: Health EOS Commercial |
$1,401.75
|
| Rate for Payer: HFN Commercial |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$945.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.00
|
| Rate for Payer: Quartz Beloit One Network |
$771.75
|
| Rate for Payer: Quartz Commercial |
$945.00
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
BLADE 15 DEGREE #8065-921501
|
Facility
OP
|
$96.00
|
|
| Hospital Charge Code |
2964169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
BLADE 15 DEGREE #8065-921501
|
Facility
IP
|
$96.00
|
|
| Hospital Charge Code |
2964169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
BLADE 2.0MM TURBINATE 1882040HR
|
Facility
IP
|
$2,357.00
|
|
| Hospital Charge Code |
6172383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.93 |
| Max. Negotiated Rate |
$2,168.44 |
| Rate for Payer: Aetna Commercial |
$2,121.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,249.21
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cigna Commercial |
$2,168.44
|
| Rate for Payer: Health EOS Commercial |
$2,097.73
|
| Rate for Payer: HFN Commercial |
$2,168.44
|
| Rate for Payer: Multiplan Commercial |
$1,885.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,414.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,168.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.93
|
| Rate for Payer: Quartz Commercial |
$1,414.20
|
| Rate for Payer: WEA Trust Commercial |
$1,296.35
|
| Rate for Payer: WPS Commercial |
$1,745.83
|
|
|
BLADE 2.0MM TURBINATE 1882040HR
|
Facility
OP
|
$2,357.00
|
|
| Hospital Charge Code |
6172383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.96 |
| Max. Negotiated Rate |
$9,428.00 |
| Rate for Payer: Aetna Commercial |
$2,121.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,027.02
|
| Rate for Payer: Aetna Managed Medicare |
$659.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,532.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,178.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,131.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,249.21
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cigna Commercial |
$2,168.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,318.98
|
| Rate for Payer: Health EOS Commercial |
$2,097.73
|
| Rate for Payer: HFN Commercial |
$2,168.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,767.75
|
| Rate for Payer: Multiplan Commercial |
$1,885.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,414.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,168.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.93
|
| Rate for Payer: Quartz Commercial |
$1,532.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,414.20
|
| Rate for Payer: The Alliance Commercial |
$9,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,296.35
|
| Rate for Payer: WPS Commercial |
$1,745.83
|
|
|
BLADE 2.6 ANG DUAL BEVEL 8065982665
|
Facility
OP
|
$1,029.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2969448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$946.68 |
| Rate for Payer: Aetna Commercial |
$926.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.94
|
| Rate for Payer: Aetna Managed Medicare |
$288.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$668.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$514.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.37
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$946.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.83
|
| Rate for Payer: Health EOS Commercial |
$915.81
|
| Rate for Payer: HFN Commercial |
$946.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$771.75
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: NAPHCARE Commercial |
$617.40
|
| Rate for Payer: Preferred Network Access Commercial |
$946.68
|
| Rate for Payer: Quartz Beloit One Network |
$504.21
|
| Rate for Payer: Quartz Commercial |
$668.85
|
| Rate for Payer: Quartz Medicare Advantage |
$617.40
|
| Rate for Payer: WEA Trust Commercial |
$565.95
|
| Rate for Payer: WPS Commercial |
$762.18
|
|
|
BLADE 2.6 ANG DUAL BEVEL 8065982665
|
Facility
IP
|
$1,029.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2969448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.21 |
| Max. Negotiated Rate |
$946.68 |
| Rate for Payer: Aetna Commercial |
$926.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.37
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$946.68
|
| Rate for Payer: Health EOS Commercial |
$915.81
|
| Rate for Payer: HFN Commercial |
$946.68
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: NAPHCARE Commercial |
$617.40
|
| Rate for Payer: Preferred Network Access Commercial |
$946.68
|
| Rate for Payer: Quartz Beloit One Network |
$504.21
|
| Rate for Payer: Quartz Commercial |
$617.40
|
| Rate for Payer: WEA Trust Commercial |
$565.95
|
| Rate for Payer: WPS Commercial |
$762.18
|
|
|
BLADE 2.6 ANGLED DUAL BEVEL
|
Facility
OP
|
$1,051.00
|
|
| Hospital Charge Code |
2974015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.28 |
| Max. Negotiated Rate |
$4,204.00 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.86
|
| Rate for Payer: Aetna Managed Medicare |
$294.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$683.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.03
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$966.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.14
|
| Rate for Payer: Health EOS Commercial |
$935.39
|
| Rate for Payer: HFN Commercial |
$966.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.25
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: NAPHCARE Commercial |
$630.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.92
|
| Rate for Payer: Quartz Beloit One Network |
$514.99
|
| Rate for Payer: Quartz Commercial |
$683.15
|
| Rate for Payer: Quartz Medicare Advantage |
$630.60
|
| Rate for Payer: The Alliance Commercial |
$4,204.00
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
BLADE 2.6 ANGLED DUAL BEVEL
|
Facility
IP
|
$1,051.00
|
|
| Hospital Charge Code |
2974015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$514.99 |
| Max. Negotiated Rate |
$966.92 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.03
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$966.92
|
| Rate for Payer: Health EOS Commercial |
$935.39
|
| Rate for Payer: HFN Commercial |
$966.92
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: NAPHCARE Commercial |
$630.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.92
|
| Rate for Payer: Quartz Beloit One Network |
$514.99
|
| Rate for Payer: Quartz Commercial |
$630.60
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
BLADE 2.9 INFERIOR TURBINATE 1882940HR
|
Facility
IP
|
$1,179.00
|
|
| Hospital Charge Code |
2965305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.71 |
| Max. Negotiated Rate |
$1,084.68 |
| Rate for Payer: Aetna Commercial |
$1,061.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.87
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,084.68
|
| Rate for Payer: Health EOS Commercial |
$1,049.31
|
| Rate for Payer: HFN Commercial |
$1,084.68
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: NAPHCARE Commercial |
$707.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.68
|
| Rate for Payer: Quartz Beloit One Network |
$577.71
|
| Rate for Payer: Quartz Commercial |
$707.40
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
BLADE 2.9 INFERIOR TURBINATE 1882940HR
|
Facility
OP
|
$1,179.00
|
|
| Hospital Charge Code |
2965305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.12 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$1,061.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.94
|
| Rate for Payer: Aetna Managed Medicare |
$330.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$766.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.87
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,084.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.77
|
| Rate for Payer: Health EOS Commercial |
$1,049.31
|
| Rate for Payer: HFN Commercial |
$1,084.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$884.25
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: NAPHCARE Commercial |
$707.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.68
|
| Rate for Payer: Quartz Beloit One Network |
$577.71
|
| Rate for Payer: Quartz Commercial |
$766.35
|
| Rate for Payer: Quartz Medicare Advantage |
$707.40
|
| Rate for Payer: The Alliance Commercial |
$4,716.00
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
BLADE 3.5 90DEG CVD 1883519HR
|
Facility
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
BLADE 3.5 90DEG CVD 1883519HR
|
Facility
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
BLADE 3.5 CUDA STRAIGHT C9253
|
Facility
IP
|
$991.00
|
|
| Hospital Charge Code |
2965519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BLADE 3.5 CUDA STRAIGHT C9253
|
Facility
OP
|
$991.00
|
|
| Hospital Charge Code |
2965519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BLADE 3.5 GREAT WHITE 9399A
|
Facility
OP
|
$991.00
|
|
| Hospital Charge Code |
2965520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BLADE 3.5 GREAT WHITE 9399A
|
Facility
IP
|
$991.00
|
|
| Hospital Charge Code |
2965520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
BLADE 3.7MM GREAT WHITE MERLIN 15 DEG BENDABLE 37GRW-ME-PB
|
Facility
IP
|
$1,265.00
|
|
| Hospital Charge Code |
4304508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.85 |
| Max. Negotiated Rate |
$1,163.80 |
| Rate for Payer: Aetna Commercial |
$1,138.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.45
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,163.80
|
| Rate for Payer: Health EOS Commercial |
$1,125.85
|
| Rate for Payer: HFN Commercial |
$1,163.80
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$759.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.80
|
| Rate for Payer: Quartz Beloit One Network |
$619.85
|
| Rate for Payer: Quartz Commercial |
$759.00
|
| Rate for Payer: WEA Trust Commercial |
$695.75
|
| Rate for Payer: WPS Commercial |
$936.99
|
|
|
BLADE 3.7MM GREAT WHITE MERLIN 15 DEG BENDABLE 37GRW-ME-PB
|
Facility
OP
|
$1,265.00
|
|
| Hospital Charge Code |
4304508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$5,060.00 |
| Rate for Payer: Aetna Commercial |
$1,138.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.90
|
| Rate for Payer: Aetna Managed Medicare |
$354.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.45
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,163.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.89
|
| Rate for Payer: Health EOS Commercial |
$1,125.85
|
| Rate for Payer: HFN Commercial |
$1,163.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.75
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$759.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.80
|
| Rate for Payer: Quartz Beloit One Network |
$619.85
|
| Rate for Payer: Quartz Commercial |
$822.25
|
| Rate for Payer: Quartz Medicare Advantage |
$759.00
|
| Rate for Payer: The Alliance Commercial |
$5,060.00
|
| Rate for Payer: WEA Trust Commercial |
$695.75
|
| Rate for Payer: WPS Commercial |
$936.99
|
|
|
BLADE 4.0MM TRICUT 1884004HR
|
Facility
IP
|
$1,225.00
|
|
| Hospital Charge Code |
2965307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.25 |
| Max. Negotiated Rate |
$1,127.00 |
| Rate for Payer: Aetna Commercial |
$1,102.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.25
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$1,127.00
|
| Rate for Payer: Health EOS Commercial |
$1,090.25
|
| Rate for Payer: HFN Commercial |
$1,127.00
|
| Rate for Payer: Multiplan Commercial |
$980.00
|
| Rate for Payer: NAPHCARE Commercial |
$735.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.00
|
| Rate for Payer: Quartz Beloit One Network |
$600.25
|
| Rate for Payer: Quartz Commercial |
$735.00
|
| Rate for Payer: WEA Trust Commercial |
$673.75
|
| Rate for Payer: WPS Commercial |
$907.36
|
|
|
BLADE 4.0MM TRICUT 1884004HR
|
Facility
OP
|
$1,225.00
|
|
| Hospital Charge Code |
2965307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna Commercial |
$1,102.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,053.50
|
| Rate for Payer: Aetna Managed Medicare |
$343.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$796.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$612.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.25
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$1,127.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$685.51
|
| Rate for Payer: Health EOS Commercial |
$1,090.25
|
| Rate for Payer: HFN Commercial |
$1,127.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$918.75
|
| Rate for Payer: Multiplan Commercial |
$980.00
|
| Rate for Payer: NAPHCARE Commercial |
$735.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.00
|
| Rate for Payer: Quartz Beloit One Network |
$600.25
|
| Rate for Payer: Quartz Commercial |
$796.25
|
| Rate for Payer: Quartz Medicare Advantage |
$735.00
|
| Rate for Payer: The Alliance Commercial |
$4,900.00
|
| Rate for Payer: WEA Trust Commercial |
$673.75
|
| Rate for Payer: WPS Commercial |
$907.36
|
|
|
BLADE 4.2 CUDA CURVED C9256
|
Facility
OP
|
$1,709.00
|
|
| Hospital Charge Code |
2965522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.52 |
| Max. Negotiated Rate |
$6,836.00 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Aetna Managed Medicare |
$478.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.77
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,572.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.36
|
| Rate for Payer: Health EOS Commercial |
$1,521.01
|
| Rate for Payer: HFN Commercial |
$1,572.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.75
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.28
|
| Rate for Payer: Quartz Beloit One Network |
$837.41
|
| Rate for Payer: Quartz Commercial |
$1,110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,025.40
|
| Rate for Payer: The Alliance Commercial |
$6,836.00
|
| Rate for Payer: WEA Trust Commercial |
$939.95
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
BLADE 4.2 CUDA CURVED C9256
|
Facility
IP
|
$1,709.00
|
|
| Hospital Charge Code |
2965522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.41 |
| Max. Negotiated Rate |
$1,572.28 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.77
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,572.28
|
| Rate for Payer: Health EOS Commercial |
$1,521.01
|
| Rate for Payer: HFN Commercial |
$1,572.28
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.28
|
| Rate for Payer: Quartz Beloit One Network |
$837.41
|
| Rate for Payer: Quartz Commercial |
$1,025.40
|
| Rate for Payer: WEA Trust Commercial |
$939.95
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
BLADE 4.2 CUDA STRAIGHT C9254
|
Facility
OP
|
$991.00
|
|
| Hospital Charge Code |
2965523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
