|
BLADE 25.0 X 5.5 2296-3-414
|
Facility
|
IP
|
$816.00
|
|
| Hospital Charge Code |
2971665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$750.72 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$750.72
|
| Rate for Payer: Health EOS Commercial |
$726.24
|
| Rate for Payer: HFN Commercial |
$750.72
|
| Rate for Payer: Multiplan Commercial |
$652.80
|
| Rate for Payer: NAPHCARE Commercial |
$489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$750.72
|
| Rate for Payer: Quartz Beloit One Network |
$399.84
|
| Rate for Payer: Quartz Commercial |
$489.60
|
| Rate for Payer: WEA Trust Commercial |
$448.80
|
| Rate for Payer: WPS Commercial |
$604.41
|
|
|
BLADE 25.0 X 5.5 2296-3-414
|
Facility
|
OP
|
$816.00
|
|
| Hospital Charge Code |
2971665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.48 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.76
|
| Rate for Payer: Aetna Managed Medicare |
$228.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$530.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$750.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.63
|
| Rate for Payer: Health EOS Commercial |
$726.24
|
| Rate for Payer: HFN Commercial |
$750.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.00
|
| Rate for Payer: Multiplan Commercial |
$652.80
|
| Rate for Payer: NAPHCARE Commercial |
$489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$750.72
|
| Rate for Payer: Quartz Beloit One Network |
$399.84
|
| Rate for Payer: Quartz Commercial |
$530.40
|
| Rate for Payer: Quartz Medicare Advantage |
$489.60
|
| Rate for Payer: The Alliance Commercial |
$3,264.00
|
| Rate for Payer: WEA Trust Commercial |
$448.80
|
| Rate for Payer: WPS Commercial |
$604.41
|
|
|
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 |
$4,116.00 |
| 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: The Alliance Commercial |
$4,116.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$884.94
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$903.86
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,013.94
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| 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 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 3.7MM 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: Aetna Gatekeeper/Not Gatekeeper |
$1,087.90
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$1,053.50
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| 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 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 STRAIGHT C9254
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| 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 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
|
|
|
BLADE 4.2 FULL RADIUS 9247A
|
Facility
|
OP
|
$1,343.00
|
|
| Hospital Charge Code |
2964871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.04 |
| Max. Negotiated Rate |
$5,372.00 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.98
|
| Rate for Payer: Aetna Managed Medicare |
$376.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.79
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,235.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.54
|
| Rate for Payer: Health EOS Commercial |
$1,195.27
|
| Rate for Payer: HFN Commercial |
$1,235.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,007.25
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$805.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.56
|
| Rate for Payer: Quartz Beloit One Network |
$658.07
|
| Rate for Payer: Quartz Commercial |
$872.95
|
| Rate for Payer: Quartz Medicare Advantage |
$805.80
|
| Rate for Payer: The Alliance Commercial |
$5,372.00
|
| Rate for Payer: WEA Trust Commercial |
$738.65
|
| Rate for Payer: WPS Commercial |
$994.76
|
|
|
BLADE 4.2 FULL RADIUS 9247A
|
Facility
|
IP
|
$1,343.00
|
|
| Hospital Charge Code |
2964871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$658.07 |
| Max. Negotiated Rate |
$1,235.56 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.79
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,235.56
|
| Rate for Payer: Health EOS Commercial |
$1,195.27
|
| Rate for Payer: HFN Commercial |
$1,235.56
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$805.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.56
|
| Rate for Payer: Quartz Beloit One Network |
$658.07
|
| Rate for Payer: Quartz Commercial |
$805.80
|
| Rate for Payer: WEA Trust Commercial |
$738.65
|
| Rate for Payer: WPS Commercial |
$994.76
|
|
|
BLADE 4.2 FULL RADIUS C9241
|
Facility
|
OP
|
$642.00
|
|
| Hospital Charge Code |
2964870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.76 |
| Max. Negotiated Rate |
$2,568.00 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Aetna Managed Medicare |
$179.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.26
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$590.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.26
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$481.50
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$590.64
|
| Rate for Payer: Quartz Beloit One Network |
$314.58
|
| Rate for Payer: Quartz Commercial |
$417.30
|
| Rate for Payer: Quartz Medicare Advantage |
$385.20
|
| Rate for Payer: The Alliance Commercial |
$2,568.00
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
