|
BLADE LONG MEDIUM 25.0 2296-033-111
|
Facility
OP
|
$760.00
|
|
| Hospital Charge Code |
2966098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$212.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.00
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$456.00
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE LONG MEDIUM 25.0 2296-033-111
|
Facility
IP
|
$760.00
|
|
| Hospital Charge Code |
2966098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE LONG NARROW 2296-003-414
|
Facility
OP
|
$760.00
|
|
| Hospital Charge Code |
2966099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$212.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.00
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$456.00
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE LONG NARROW 2296-003-414
|
Facility
IP
|
$760.00
|
|
| Hospital Charge Code |
2966099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE LONG WIDE 2296-003-106
|
Facility
OP
|
$760.00
|
|
| Hospital Charge Code |
3070016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$212.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.00
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$456.00
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE LONG WIDE 2296-003-106
|
Facility
IP
|
$760.00
|
|
| Hospital Charge Code |
3070016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE MED-LONG 2108-109
|
Facility
OP
|
$963.00
|
|
| Hospital Charge Code |
2966106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.64 |
| Max. Negotiated Rate |
$3,852.00 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Aetna Managed Medicare |
$269.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.89
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.25
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$625.95
|
| Rate for Payer: Quartz Medicare Advantage |
$577.80
|
| Rate for Payer: The Alliance Commercial |
$3,852.00
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
BLADE MED-LONG 2108-109
|
Facility
IP
|
$963.00
|
|
| Hospital Charge Code |
2966106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.87 |
| Max. Negotiated Rate |
$885.96 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$577.80
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
BLADE MED MED 18.5 2296-003-105
|
Facility
IP
|
$760.00
|
|
| Hospital Charge Code |
3070017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE MED MED 18.5 2296-003-105
|
Facility
OP
|
$760.00
|
|
| Hospital Charge Code |
3070017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$212.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.00
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$456.00
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
BLADE MIDAS REX LEGEND AF03 F3/9TA30
|
Facility
IP
|
$2,034.00
|
|
| Hospital Charge Code |
5349380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$996.66 |
| Max. Negotiated Rate |
$1,871.28 |
| Rate for Payer: Aetna Commercial |
$1,830.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.02
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,871.28
|
| Rate for Payer: Health EOS Commercial |
$1,810.26
|
| Rate for Payer: HFN Commercial |
$1,871.28
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,220.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.28
|
| Rate for Payer: Quartz Beloit One Network |
$996.66
|
| Rate for Payer: Quartz Commercial |
$1,220.40
|
| Rate for Payer: WEA Trust Commercial |
$1,118.70
|
| Rate for Payer: WPS Commercial |
$1,506.58
|
|
|
BLADE MIDAS REX LEGEND AF03 F3/9TA30
|
Facility
OP
|
$2,034.00
|
|
| Hospital Charge Code |
5349380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.52 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$1,830.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,749.24
|
| Rate for Payer: Aetna Managed Medicare |
$569.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,322.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,017.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$976.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.02
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,871.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.23
|
| Rate for Payer: Health EOS Commercial |
$1,810.26
|
| Rate for Payer: HFN Commercial |
$1,871.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,525.50
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,220.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.28
|
| Rate for Payer: Quartz Beloit One Network |
$996.66
|
| Rate for Payer: Quartz Commercial |
$1,322.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,220.40
|
| Rate for Payer: The Alliance Commercial |
$8,136.00
|
| Rate for Payer: WEA Trust Commercial |
$1,118.70
|
| Rate for Payer: WPS Commercial |
$1,506.58
|
|
|
BLADE MINI 62 12877
|
Facility
IP
|
$85.00
|
|
| Hospital Charge Code |
2971253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
BLADE MINI 62 12877
|
Facility
OP
|
$85.00
|
|
| Hospital Charge Code |
2971253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
BLADE MYRINGOTOMY MICROEDGE DOUBLE CUTTING EDGE ARROW DISP BL-0150
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
2965296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
BLADE MYRINGOTOMY MICROEDGE DOUBLE CUTTING EDGE ARROW DISP BL-0150
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
2965296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
BLADE OSTEOTOMY SAW HUB STYLE S 80-0740-S
|
Facility
OP
|
$1,613.00
|
|
| Hospital Charge Code |
4427963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
BLADE OSTEOTOMY SAW HUB STYLE S 80-0740-S
|
Facility
IP
|
$1,613.00
|
|
| Hospital Charge Code |
4427963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
BLADE PACK AM MULTI- PACK AM96BLD5
|
Facility
OP
|
$4,450.00
|
|
| Hospital Charge Code |
5729877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.00 |
| Max. Negotiated Rate |
$17,800.00 |
| Rate for Payer: Aetna Commercial |
$4,005.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,827.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,892.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,225.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,136.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,358.50
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$4,094.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,490.22
|
| Rate for Payer: Health EOS Commercial |
$3,960.50
|
| Rate for Payer: HFN Commercial |
$4,094.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,337.50
|
| Rate for Payer: Multiplan Commercial |
$3,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,670.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,094.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,180.50
|
| Rate for Payer: Quartz Commercial |
$2,892.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,670.00
|
| Rate for Payer: The Alliance Commercial |
$17,800.00
|
| Rate for Payer: WEA Trust Commercial |
$2,447.50
|
| Rate for Payer: WPS Commercial |
$3,296.12
|
|
|
BLADE PACK AM MULTI- PACK AM96BLD5
|
Facility
IP
|
$4,450.00
|
|
| Hospital Charge Code |
5729877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,180.50 |
| Max. Negotiated Rate |
$4,094.00 |
| Rate for Payer: Aetna Commercial |
$4,005.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,358.50
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$4,094.00
|
| Rate for Payer: Health EOS Commercial |
$3,960.50
|
| Rate for Payer: HFN Commercial |
$4,094.00
|
| Rate for Payer: Multiplan Commercial |
$3,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,670.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,094.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,180.50
|
| Rate for Payer: Quartz Commercial |
$2,670.00
|
| Rate for Payer: WEA Trust Commercial |
$2,447.50
|
| Rate for Payer: WPS Commercial |
$3,296.12
|
|
|
BLADE PACK AM SINGLE PACK AM96BLD1
|
Facility
IP
|
$4,596.00
|
|
| Hospital Charge Code |
5685892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,252.04 |
| Max. Negotiated Rate |
$4,228.32 |
| Rate for Payer: Aetna Commercial |
$4,136.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,435.88
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$4,228.32
|
| Rate for Payer: Health EOS Commercial |
$4,090.44
|
| Rate for Payer: HFN Commercial |
$4,228.32
|
| Rate for Payer: Multiplan Commercial |
$3,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,757.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,228.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.04
|
| Rate for Payer: Quartz Commercial |
$2,757.60
|
| Rate for Payer: WEA Trust Commercial |
$2,527.80
|
| Rate for Payer: WPS Commercial |
$3,404.26
|
|
|
BLADE PACK AM SINGLE PACK AM96BLD1
|
Facility
OP
|
$4,596.00
|
|
| Hospital Charge Code |
5685892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.88 |
| Max. Negotiated Rate |
$18,384.00 |
| Rate for Payer: Aetna Commercial |
$4,136.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,952.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,286.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,987.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,206.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,435.88
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$4,228.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,571.92
|
| Rate for Payer: Health EOS Commercial |
$4,090.44
|
| Rate for Payer: HFN Commercial |
$4,228.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,447.00
|
| Rate for Payer: Multiplan Commercial |
$3,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,757.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,228.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.04
|
| Rate for Payer: Quartz Commercial |
$2,987.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,757.60
|
| Rate for Payer: The Alliance Commercial |
$18,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,527.80
|
| Rate for Payer: WPS Commercial |
$3,404.26
|
|
|
BLADE PARALLEL GRAFT KNIFE 10MM AR-2285-10
|
Facility
IP
|
$876.00
|
|
| Hospital Charge Code |
5563229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.24 |
| Max. Negotiated Rate |
$805.92 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$525.60
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
|
BLADE PARALLEL GRAFT KNIFE 10MM AR-2285-10
|
Facility
OP
|
$876.00
|
|
| Hospital Charge Code |
5563229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.28 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Aetna Managed Medicare |
$245.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.21
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.00
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$569.40
|
| Rate for Payer: Quartz Medicare Advantage |
$525.60
|
| Rate for Payer: The Alliance Commercial |
$3,504.00
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
|
BLADE PARALLEL GRAFT KNIFE 9MM AR-2285-09
|
Facility
OP
|
$876.00
|
|
| Hospital Charge Code |
5496931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.28 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Aetna Managed Medicare |
$245.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.21
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.00
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$569.40
|
| Rate for Payer: Quartz Medicare Advantage |
$525.60
|
| Rate for Payer: The Alliance Commercial |
$3,504.00
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
