|
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 |
$644.64 |
| Max. Negotiated Rate |
$1,210.35 |
| Rate for Payer: Aetna Commercial |
$1,184.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,131.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.27
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,210.35
|
| Rate for Payer: Health EOS Commercial |
$1,170.88
|
| Rate for Payer: HFN Commercial |
$1,210.35
|
| Rate for Payer: Multiplan Commercial |
$1,052.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,210.35
|
| Rate for Payer: Quartz Beloit One Network |
$644.64
|
| Rate for Payer: Quartz Commercial |
$789.36
|
| Rate for Payer: WEA Trust Commercial |
$723.58
|
| Rate for Payer: WPS Commercial |
$974.43
|
|
|
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 |
$368.37 |
| Max. Negotiated Rate |
$1,210.35 |
| Rate for Payer: Aetna Commercial |
$1,184.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,131.42
|
| Rate for Payer: Aetna Managed Medicare |
$368.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$855.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.27
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,210.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.23
|
| Rate for Payer: Health EOS Commercial |
$1,170.88
|
| Rate for Payer: HFN Commercial |
$1,210.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.70
|
| Rate for Payer: Multiplan Commercial |
$1,052.48
|
| Rate for Payer: NAPHCARE Commercial |
$789.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,210.35
|
| Rate for Payer: Quartz Beloit One Network |
$644.64
|
| Rate for Payer: Quartz Commercial |
$855.14
|
| Rate for Payer: Quartz Medicare Advantage |
$789.36
|
| Rate for Payer: The Alliance Commercial |
$657.80
|
| Rate for Payer: WEA Trust Commercial |
$723.58
|
| Rate for Payer: WPS Commercial |
$974.43
|
|
|
BLADE 4.0MM TRICUT 1884004HR
|
Facility
|
OP
|
$1,225.00
|
|
| Hospital Charge Code |
2965307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$1,172.08 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Aetna Managed Medicare |
$356.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$712.95
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$955.50
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$764.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$828.10
|
| Rate for Payer: Quartz Medicare Advantage |
$764.40
|
| Rate for Payer: The Alliance Commercial |
$637.00
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: WPS Commercial |
$943.62
|
|
|
BLADE 4.0MM TRICUT 1884004HR
|
Facility
|
IP
|
$1,225.00
|
|
| Hospital Charge Code |
2965307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.26 |
| Max. Negotiated Rate |
$1,172.08 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$764.40
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: WPS Commercial |
$943.62
|
|
|
BLADE 4.2 CUDA CURVED C9256
|
Facility
|
IP
|
$1,709.00
|
|
| Hospital Charge Code |
2965522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
BLADE 4.2 CUDA CURVED C9256
|
Facility
|
OP
|
$1,709.00
|
|
| Hospital Charge Code |
2965522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.66 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$497.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.02
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.42
|
| Rate for Payer: The Alliance Commercial |
$888.68
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
BLADE 4.2 CUDA STRAIGHT C9254
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965523
|
|
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 4.2 CUDA STRAIGHT C9254
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965523
|
|
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 4.2 FULL RADIUS 9247A
|
Facility
|
IP
|
$1,343.00
|
|
| Hospital Charge Code |
2964871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.39 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$838.03
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
BLADE 4.2 FULL RADIUS 9247A
|
Facility
|
OP
|
$1,343.00
|
|
| Hospital Charge Code |
2964871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.08 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Aetna Managed Medicare |
$391.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$698.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$670.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.63
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,047.54
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: NAPHCARE Commercial |
$838.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$907.87
|
| Rate for Payer: Quartz Medicare Advantage |
$838.03
|
| Rate for Payer: The Alliance Commercial |
$698.36
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
BLADE 4.2 FULL RADIUS C9241
|
Facility
|
IP
|
$642.00
|
|
| Hospital Charge Code |
2964870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.16 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$400.61
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
BLADE 4.2 FULL RADIUS C9241
|
Facility
|
OP
|
$642.00
|
|
| Hospital Charge Code |
2964870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.95 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Aetna Managed Medicare |
$186.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$433.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.64
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$500.76
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: NAPHCARE Commercial |
$400.61
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$433.99
|
| Rate for Payer: Quartz Medicare Advantage |
$400.61
|
| Rate for Payer: The Alliance Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
BLADE 4.2 GREAT WHITE 9299A
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965521
|
|
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 4.2 GREAT WHITE 9299A
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965521
|
|
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 4.2 GREAT WHITE BENT C9299M
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965525
|
|
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 4.2 GREAT WHITE BENT C9299M
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965525
|
|
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 4.2 SLOTTED WHISKER C9274
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965532
|
|
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 4.2 SLOTTED WHISKER C9274
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965532
|
|
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 4.8 GATOR C9262
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2964872
|
|
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 4.8 GATOR C9262
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2964872
|
|
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 48MM SPIRAL TITANIUM
|
Facility
|
OP
|
$6,225.00
|
|
| Hospital Charge Code |
2966151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,812.72 |
| Max. Negotiated Rate |
$5,956.08 |
| Rate for Payer: Aetna Commercial |
$5,826.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,567.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,812.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,208.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,107.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,431.22
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$5,956.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,622.95
|
| Rate for Payer: Health EOS Commercial |
$5,761.86
|
| Rate for Payer: HFN Commercial |
$5,956.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,855.50
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,884.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,956.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,172.26
|
| Rate for Payer: Quartz Commercial |
$4,208.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,884.40
|
| Rate for Payer: The Alliance Commercial |
$3,237.00
|
| Rate for Payer: WEA Trust Commercial |
$3,560.70
|
| Rate for Payer: WPS Commercial |
$4,795.12
|
|
|
BLADE 48MM SPIRAL TITANIUM
|
Facility
|
IP
|
$6,225.00
|
|
| Hospital Charge Code |
2966151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,172.26 |
| Max. Negotiated Rate |
$5,956.08 |
| Rate for Payer: Aetna Commercial |
$5,826.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,567.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,431.22
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$5,956.08
|
| Rate for Payer: Health EOS Commercial |
$5,761.86
|
| Rate for Payer: HFN Commercial |
$5,956.08
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,956.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,172.26
|
| Rate for Payer: Quartz Commercial |
$3,884.40
|
| Rate for Payer: WEA Trust Commercial |
$3,560.70
|
| Rate for Payer: WPS Commercial |
$4,795.12
|
|
|
BLADE 4MM TRICUT 188404
|
Facility
|
OP
|
$1,179.00
|
|
| Hospital Charge Code |
2965308
|
|
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 4MM TRICUT 188404
|
Facility
|
IP
|
$1,179.00
|
|
| Hospital Charge Code |
2965308
|
|
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 5.2 ANGLED SLIT 8065995661
|
Facility
|
OP
|
$534.00
|
|
| Hospital Charge Code |
2964179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$510.93 |
| Rate for Payer: Aetna Commercial |
$499.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| Rate for Payer: Aetna Managed Medicare |
$155.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$360.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$277.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.34
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$510.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.79
|
| Rate for Payer: Health EOS Commercial |
$494.27
|
| Rate for Payer: HFN Commercial |
$510.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.52
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: NAPHCARE Commercial |
$333.22
|
| Rate for Payer: Preferred Network Access Commercial |
$510.93
|
| Rate for Payer: Quartz Beloit One Network |
$272.13
|
| Rate for Payer: Quartz Commercial |
$360.98
|
| Rate for Payer: Quartz Medicare Advantage |
$333.22
|
| Rate for Payer: The Alliance Commercial |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$411.34
|
|
