|
BLADE SPIRAL 42MM TITANIUM
|
Facility
OP
|
$6,224.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.72 |
| Max. Negotiated Rate |
$5,726.08 |
| Rate for Payer: Aetna Commercial |
$5,601.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,112.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.72
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,726.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.95
|
| Rate for Payer: Health EOS Commercial |
$5,539.36
|
| Rate for Payer: HFN Commercial |
$5,726.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,668.00
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,726.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.76
|
| Rate for Payer: Quartz Commercial |
$4,045.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.40
|
| Rate for Payer: WEA Trust Commercial |
$3,423.20
|
| Rate for Payer: WPS Commercial |
$4,610.12
|
|
|
BLADE STERNUM REVISION SAGITTAL SAFEDGE 2108-125-000
|
Facility
OP
|
$843.00
|
|
| Hospital Charge Code |
4519117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.04 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$758.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.98
|
| Rate for Payer: Aetna Managed Medicare |
$236.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.79
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$775.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.74
|
| Rate for Payer: Health EOS Commercial |
$750.27
|
| Rate for Payer: HFN Commercial |
$775.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.25
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: NAPHCARE Commercial |
$505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.56
|
| Rate for Payer: Quartz Beloit One Network |
$413.07
|
| Rate for Payer: Quartz Commercial |
$547.95
|
| Rate for Payer: Quartz Medicare Advantage |
$505.80
|
| Rate for Payer: The Alliance Commercial |
$3,372.00
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
BLADE STERNUM REVISION SAGITTAL SAFEDGE 2108-125-000
|
Facility
IP
|
$843.00
|
|
| Hospital Charge Code |
4519117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.07 |
| Max. Negotiated Rate |
$775.56 |
| Rate for Payer: Aetna Commercial |
$758.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.79
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$775.56
|
| Rate for Payer: Health EOS Commercial |
$750.27
|
| Rate for Payer: HFN Commercial |
$775.56
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: NAPHCARE Commercial |
$505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.56
|
| Rate for Payer: Quartz Beloit One Network |
$413.07
|
| Rate for Payer: Quartz Commercial |
$505.80
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
BLADE STERNUM SAW 5059-532
|
Facility
IP
|
$153.00
|
|
| Hospital Charge Code |
2965526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
BLADE STERNUM SAW 5059-532
|
Facility
OP
|
$153.00
|
|
| Hospital Charge Code |
2965526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$91.80
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
BLADE STERNUM SAW STRYKER 298-97-100
|
Facility
IP
|
$541.00
|
|
| Hospital Charge Code |
4518781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.09 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$324.60
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
BLADE STERNUM SAW STRYKER 298-97-100
|
Facility
OP
|
$541.00
|
|
| Hospital Charge Code |
4518781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.48 |
| Max. Negotiated Rate |
$2,164.00 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Aetna Managed Medicare |
$151.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.74
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.75
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$351.65
|
| Rate for Payer: Quartz Medicare Advantage |
$324.60
|
| Rate for Payer: The Alliance Commercial |
$2,164.00
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
BLADE TENDON STRIPPER 10MM AR-2385-10
|
Facility
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5563609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
BLADE TENDON STRIPPER 10MM AR-2385-10
|
Facility
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5563609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE 73-1191
|
Facility
OP
|
$3,140.00
|
|
| Hospital Charge Code |
5349393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$12,560.00 |
| Rate for Payer: Aetna Commercial |
$2,826.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,700.40
|
| Rate for Payer: Aetna Managed Medicare |
$879.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,041.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,570.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,664.20
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$2,888.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,757.14
|
| Rate for Payer: Health EOS Commercial |
$2,794.60
|
| Rate for Payer: HFN Commercial |
$2,888.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,355.00
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,884.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,888.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.60
|
| Rate for Payer: Quartz Commercial |
$2,041.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,884.00
|
| Rate for Payer: The Alliance Commercial |
$12,560.00
|
| Rate for Payer: WEA Trust Commercial |
$1,727.00
|
| Rate for Payer: WPS Commercial |
$2,325.80
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE 73-1191
|
Facility
IP
|
$3,140.00
|
|
| Hospital Charge Code |
5349393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,538.60 |
| Max. Negotiated Rate |
$2,888.80 |
| Rate for Payer: Aetna Commercial |
$2,826.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,664.20
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$2,888.80
|
| Rate for Payer: Health EOS Commercial |
$2,794.60
|
| Rate for Payer: HFN Commercial |
$2,888.80
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,884.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,888.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.60
|
| Rate for Payer: Quartz Commercial |
$1,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,727.00
|
| Rate for Payer: WPS Commercial |
$2,325.80
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE STANDARD 73-1194
|
Facility
OP
|
$1,664.00
|
|
| Hospital Charge Code |
5659737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$6,656.00 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$465.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.17
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$998.40
|
| Rate for Payer: The Alliance Commercial |
$6,656.00
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE STANDARD 73-1194
|
Facility
IP
|
$1,664.00
|
|
| Hospital Charge Code |
5659737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
BLAKE DRAIN SILICONE 15FR ROUND HUBLESS 3/16 IN TROCAR 2229
|
Facility
OP
|
$2,081.95
|
|
| Hospital Charge Code |
6246183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.95 |
| Max. Negotiated Rate |
$8,327.80 |
| Rate for Payer: Aetna Commercial |
$1,873.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,790.48
|
| Rate for Payer: Aetna Managed Medicare |
$582.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,353.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,040.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$999.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,103.43
|
| Rate for Payer: Cash Price |
$624.58
|
| Rate for Payer: Cigna Commercial |
$1,915.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,165.06
|
| Rate for Payer: Health EOS Commercial |
$1,852.94
|
| Rate for Payer: HFN Commercial |
$1,915.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,561.46
|
| Rate for Payer: Multiplan Commercial |
$1,665.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,249.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,915.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,020.16
|
| Rate for Payer: Quartz Commercial |
$1,353.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,249.17
|
| Rate for Payer: The Alliance Commercial |
$8,327.80
|
| Rate for Payer: WEA Trust Commercial |
$1,145.07
|
| Rate for Payer: WPS Commercial |
$1,542.10
|
|
|
BLAKE DRAIN SILICONE 15FR ROUND HUBLESS 3/16 IN TROCAR 2229
|
Facility
IP
|
$2,081.95
|
|
| Hospital Charge Code |
6246183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,020.16 |
| Max. Negotiated Rate |
$1,915.39 |
| Rate for Payer: Aetna Commercial |
$1,873.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,103.43
|
| Rate for Payer: Cash Price |
$624.58
|
| Rate for Payer: Cigna Commercial |
$1,915.39
|
| Rate for Payer: Health EOS Commercial |
$1,852.94
|
| Rate for Payer: HFN Commercial |
$1,915.39
|
| Rate for Payer: Multiplan Commercial |
$1,665.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,249.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,915.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,020.16
|
| Rate for Payer: Quartz Commercial |
$1,249.17
|
| Rate for Payer: WEA Trust Commercial |
$1,145.07
|
| Rate for Payer: WPS Commercial |
$1,542.10
|
|
|
Blanket, Bair Hugger
|
Facility
IP
|
$61.00
|
|
| Hospital Charge Code |
3101756
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Blanket, Bair Hugger
|
Facility
OP
|
$61.00
|
|
| Hospital Charge Code |
3101756
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
BLANKET FULL BODY AIR WARMING #40034
|
Facility
OP
|
$61.00
|
|
| Hospital Charge Code |
2964000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
BLANKET FULL BODY AIR WARMING #40034
|
Facility
IP
|
$61.00
|
|
| Hospital Charge Code |
2964000
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
BLANKET LOWER BODY AIR WARMING BAIR HUGGER #42534
|
Facility
IP
|
$163.00
|
|
| Hospital Charge Code |
2972071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
BLANKET LOWER BODY AIR WARMING BAIR HUGGER #42534
|
Facility
OP
|
$163.00
|
|
| Hospital Charge Code |
2972071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
BLANKET UNDERBODY FULL ACCESS #63500
|
Facility
OP
|
$634.00
|
|
| Hospital Charge Code |
2965811
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$177.52 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.24
|
| Rate for Payer: Aetna Managed Medicare |
$177.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.02
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$583.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.79
|
| Rate for Payer: Health EOS Commercial |
$564.26
|
| Rate for Payer: HFN Commercial |
$583.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: NAPHCARE Commercial |
$380.40
|
| Rate for Payer: Preferred Network Access Commercial |
$583.28
|
| Rate for Payer: Quartz Beloit One Network |
$310.66
|
| Rate for Payer: Quartz Commercial |
$412.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.40
|
| Rate for Payer: The Alliance Commercial |
$2,536.00
|
| Rate for Payer: WEA Trust Commercial |
$348.70
|
| Rate for Payer: WPS Commercial |
$469.60
|
|
|
BLANKET UNDERBODY FULL ACCESS #63500
|
Facility
IP
|
$634.00
|
|
| Hospital Charge Code |
2965811
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$310.66 |
| Max. Negotiated Rate |
$583.28 |
| Rate for Payer: Aetna Commercial |
$570.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.02
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$583.28
|
| Rate for Payer: Health EOS Commercial |
$564.26
|
| Rate for Payer: HFN Commercial |
$583.28
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: NAPHCARE Commercial |
$380.40
|
| Rate for Payer: Preferred Network Access Commercial |
$583.28
|
| Rate for Payer: Quartz Beloit One Network |
$310.66
|
| Rate for Payer: Quartz Commercial |
$380.40
|
| Rate for Payer: WEA Trust Commercial |
$348.70
|
| Rate for Payer: WPS Commercial |
$469.60
|
|
|
BLANKET UPPER BODY AIR WARMING #42234
|
Facility
OP
|
$181.00
|
|
| Hospital Charge Code |
2969960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$724.00 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Aetna Managed Medicare |
$50.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.29
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$108.60
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$117.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.60
|
| Rate for Payer: The Alliance Commercial |
$724.00
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
BLANKET UPPER BODY AIR WARMING #42234
|
Facility
IP
|
$181.00
|
|
| Hospital Charge Code |
2969960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$108.60
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$108.60
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
