|
BLADE 10MM FLEXIBLE OSTEOTOME 71369210
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2965974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.00 |
| Max. Negotiated Rate |
$1,545.23 |
| Rate for Payer: Aetna Commercial |
$1,511.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,444.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.19
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,545.23
|
| Rate for Payer: Health EOS Commercial |
$1,494.84
|
| Rate for Payer: HFN Commercial |
$1,545.23
|
| Rate for Payer: Multiplan Commercial |
$1,343.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,545.23
|
| Rate for Payer: Quartz Beloit One Network |
$823.00
|
| Rate for Payer: Quartz Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$923.78
|
| Rate for Payer: WPS Commercial |
$1,244.03
|
|
|
BLADE 12MM FLEXIBLE OSTEOTOME 71369212
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2965976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
BLADE 12MM FLEXIBLE OSTEOTOME 71369212
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2965976
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.11 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$453.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.59
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.68
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$1,051.86
|
| Rate for Payer: Quartz Medicare Advantage |
$970.94
|
| Rate for Payer: The Alliance Commercial |
$809.12
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
BLADE 12MM FLEX OSTEOTOME RND 71369412
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2965975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.11 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$453.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.59
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.68
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$1,051.86
|
| Rate for Payer: Quartz Medicare Advantage |
$970.94
|
| Rate for Payer: The Alliance Commercial |
$809.12
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
BLADE 12MM FLEX OSTEOTOME RND 71369412
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2965975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
BLADE 15.0 CRESCENT
|
Facility
|
OP
|
$1,575.00
|
|
| Hospital Charge Code |
2966137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.64 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Aetna Managed Medicare |
$458.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.65
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.50
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$982.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$1,064.70
|
| Rate for Payer: Quartz Medicare Advantage |
$982.80
|
| Rate for Payer: The Alliance Commercial |
$819.00
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
BLADE 15.0 CRESCENT
|
Facility
|
IP
|
$1,575.00
|
|
| Hospital Charge Code |
2966137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.62 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
BLADE 15 DEGREE #8065-921501
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
2964169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
BLADE 15 DEGREE #8065-921501
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
2964169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$27.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.87
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: Quartz Medicare Advantage |
$59.90
|
| Rate for Payer: The Alliance Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
BLADE 2.0MM TURBINATE 1882040HR
|
Facility
|
OP
|
$2,357.00
|
|
| Hospital Charge Code |
6172383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.36 |
| Max. Negotiated Rate |
$2,255.18 |
| Rate for Payer: Aetna Commercial |
$2,206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,108.10
|
| Rate for Payer: Aetna Managed Medicare |
$686.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,593.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,225.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,176.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,299.18
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cigna Commercial |
$2,255.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.77
|
| Rate for Payer: Health EOS Commercial |
$2,181.64
|
| Rate for Payer: HFN Commercial |
$2,255.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,838.46
|
| Rate for Payer: Multiplan Commercial |
$1,961.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,255.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,201.13
|
| Rate for Payer: Quartz Commercial |
$1,593.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,470.77
|
| Rate for Payer: The Alliance Commercial |
$1,225.64
|
| Rate for Payer: WEA Trust Commercial |
$1,348.20
|
| Rate for Payer: WPS Commercial |
$1,815.60
|
|
|
BLADE 2.0MM TURBINATE 1882040HR
|
Facility
|
IP
|
$2,357.00
|
|
| Hospital Charge Code |
6172383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,201.13 |
| Max. Negotiated Rate |
$2,255.18 |
| Rate for Payer: Aetna Commercial |
$2,206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,108.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,299.18
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cigna Commercial |
$2,255.18
|
| Rate for Payer: Health EOS Commercial |
$2,181.64
|
| Rate for Payer: HFN Commercial |
$2,255.18
|
| Rate for Payer: Multiplan Commercial |
$1,961.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,255.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,201.13
|
| Rate for Payer: Quartz Commercial |
$1,470.77
|
| Rate for Payer: WEA Trust Commercial |
$1,348.20
|
| Rate for Payer: WPS Commercial |
$1,815.60
|
|
|
BLADE 25.0 X 5.5 2296-3-414
|
Facility
|
IP
|
$816.00
|
|
| Hospital Charge Code |
2971665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.83 |
| Max. Negotiated Rate |
$780.75 |
| Rate for Payer: Aetna Commercial |
$763.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.78
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$780.75
|
| Rate for Payer: Health EOS Commercial |
$755.29
|
| Rate for Payer: HFN Commercial |
$780.75
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: Preferred Network Access Commercial |
$780.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.83
|
| Rate for Payer: Quartz Commercial |
$509.18
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$628.56
|
|
|
BLADE 25.0 X 5.5 2296-3-414
|
Facility
|
OP
|
$816.00
|
|
| Hospital Charge Code |
2971665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.62 |
| Max. Negotiated Rate |
$780.75 |
| Rate for Payer: Aetna Commercial |
$763.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Aetna Managed Medicare |
$237.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$551.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.78
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$780.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$474.91
|
| Rate for Payer: Health EOS Commercial |
$755.29
|
| Rate for Payer: HFN Commercial |
$780.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.48
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: NAPHCARE Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$780.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.83
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: Quartz Medicare Advantage |
$509.18
|
| Rate for Payer: The Alliance Commercial |
$424.32
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$628.56
|
|
|
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 |
$299.64 |
| Max. Negotiated Rate |
$984.55 |
| Rate for Payer: Aetna Commercial |
$963.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.34
|
| Rate for Payer: Aetna Managed Medicare |
$299.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$695.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.18
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$984.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.88
|
| Rate for Payer: Health EOS Commercial |
$952.44
|
| Rate for Payer: HFN Commercial |
$984.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$802.62
|
| Rate for Payer: Multiplan Commercial |
$856.13
|
| Rate for Payer: NAPHCARE Commercial |
$642.10
|
| Rate for Payer: Preferred Network Access Commercial |
$984.55
|
| Rate for Payer: Quartz Beloit One Network |
$524.38
|
| Rate for Payer: Quartz Commercial |
$695.60
|
| Rate for Payer: Quartz Medicare Advantage |
$642.10
|
| Rate for Payer: The Alliance Commercial |
$535.08
|
| Rate for Payer: WEA Trust Commercial |
$588.59
|
| Rate for Payer: WPS Commercial |
$792.64
|
|
|
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 |
$524.38 |
| Max. Negotiated Rate |
$984.55 |
| Rate for Payer: Aetna Commercial |
$963.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.18
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$984.55
|
| Rate for Payer: Health EOS Commercial |
$952.44
|
| Rate for Payer: HFN Commercial |
$984.55
|
| Rate for Payer: Multiplan Commercial |
$856.13
|
| Rate for Payer: Preferred Network Access Commercial |
$984.55
|
| Rate for Payer: Quartz Beloit One Network |
$524.38
|
| Rate for Payer: Quartz Commercial |
$642.10
|
| Rate for Payer: WEA Trust Commercial |
$588.59
|
| Rate for Payer: WPS Commercial |
$792.64
|
|
|
BLADE 2.6 ANGLED DUAL BEVEL
|
Facility
|
IP
|
$1,051.00
|
|
| Hospital Charge Code |
2974015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.59 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$655.82
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
BLADE 2.6 ANGLED DUAL BEVEL
|
Facility
|
OP
|
$1,051.00
|
|
| Hospital Charge Code |
2974015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.05 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Aetna Managed Medicare |
$306.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$710.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.68
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.78
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: NAPHCARE Commercial |
$655.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$710.48
|
| Rate for Payer: Quartz Medicare Advantage |
$655.82
|
| Rate for Payer: The Alliance Commercial |
$546.52
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
BLADE 2.9 INFERIOR TURBINATE 1882940HR
|
Facility
|
IP
|
$1,179.00
|
|
| Hospital Charge Code |
2965305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$735.70
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
BLADE 2.9 INFERIOR TURBINATE 1882940HR
|
Facility
|
OP
|
$1,179.00
|
|
| Hospital Charge Code |
2965305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.32 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Aetna Managed Medicare |
$343.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.18
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$919.62
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: NAPHCARE Commercial |
$735.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$797.00
|
| Rate for Payer: Quartz Medicare Advantage |
$735.70
|
| Rate for Payer: The Alliance Commercial |
$613.08
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
BLADE 3.5 90DEG CVD 1883519HR
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
BLADE 3.5 90DEG CVD 1883519HR
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
BLADE 3.5 CUDA STRAIGHT C9253
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
BLADE 3.5 CUDA STRAIGHT C9253
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
BLADE 3.5 GREAT WHITE 9399A
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
BLADE 3.5 GREAT WHITE 9399A
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
