|
BLADE 5.2 ANGLED SLIT 8065995661
|
Facility
|
IP
|
$534.00
|
|
| Hospital Charge Code |
2964179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.13 |
| Max. Negotiated Rate |
$510.93 |
| Rate for Payer: Aetna Commercial |
$499.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| 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: Health EOS Commercial |
$494.27
|
| Rate for Payer: HFN Commercial |
$510.93
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: Preferred Network Access Commercial |
$510.93
|
| Rate for Payer: Quartz Beloit One Network |
$272.13
|
| Rate for Payer: Quartz Commercial |
$333.22
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$411.34
|
|
|
BLADE 5.5 CUDA C9255
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965524
|
|
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 5.5 CUDA C9255
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965524
|
|
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 69 BEAVER 376900
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
2965511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.94
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$45.55
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$45.55
|
| Rate for Payer: The Alliance Commercial |
$37.96
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
BLADE 69 BEAVER 376900
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
2965511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
BLADE 8MM FLEXIBLE OSTEOTOME 71369208
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2965977
|
|
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 8MM FLEXIBLE OSTEOTOME 71369208
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2965977
|
|
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 9.5 CRESCENT
|
Facility
|
IP
|
$1,575.00
|
|
| Hospital Charge Code |
2966138
|
|
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 9.5 CRESCENT
|
Facility
|
OP
|
$1,575.00
|
|
| Hospital Charge Code |
2966138
|
|
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 ADENOID PEAK PLASMABLADE PS300-03
|
Facility
|
IP
|
$3,832.00
|
|
| Hospital Charge Code |
4520267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,952.79 |
| Max. Negotiated Rate |
$3,666.46 |
| Rate for Payer: Aetna Commercial |
$3,586.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,427.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,112.20
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,666.46
|
| Rate for Payer: Health EOS Commercial |
$3,546.90
|
| Rate for Payer: HFN Commercial |
$3,666.46
|
| Rate for Payer: Multiplan Commercial |
$3,188.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,666.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,952.79
|
| Rate for Payer: Quartz Commercial |
$2,391.17
|
| Rate for Payer: WEA Trust Commercial |
$2,191.90
|
| Rate for Payer: WPS Commercial |
$2,951.79
|
|
|
BLADE ADENOID PEAK PLASMABLADE PS300-03
|
Facility
|
OP
|
$3,832.00
|
|
| Hospital Charge Code |
4520267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,115.88 |
| Max. Negotiated Rate |
$3,666.46 |
| Rate for Payer: Aetna Commercial |
$3,586.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,427.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,115.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,590.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,992.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,912.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,112.20
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,666.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,230.22
|
| Rate for Payer: Health EOS Commercial |
$3,546.90
|
| Rate for Payer: HFN Commercial |
$3,666.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,988.96
|
| Rate for Payer: Multiplan Commercial |
$3,188.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,391.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,666.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,952.79
|
| Rate for Payer: Quartz Commercial |
$2,590.43
|
| Rate for Payer: Quartz Medicare Advantage |
$2,391.17
|
| Rate for Payer: The Alliance Commercial |
$1,992.64
|
| Rate for Payer: WEA Trust Commercial |
$2,191.90
|
| Rate for Payer: WPS Commercial |
$2,951.79
|
|
|
BLADE BEAVER ROUND TIP 376400
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
2965512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.94
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$45.55
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$45.55
|
| Rate for Payer: The Alliance Commercial |
$37.96
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
BLADE BEAVER ROUND TIP 376400
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
2965512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
BLADE CLIPPER CARDINAL BLUE 4406
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
2963159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
BLADE CLIPPER CARDINAL BLUE 4406
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
2963159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
BLADE CLIPPER SENSICLIP PINK 4403A
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2965815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
BLADE CLIPPER SENSICLIP PINK 4403A
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2965815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
BLADE CRESCENT STR 8065990001
|
Facility
|
IP
|
$534.00
|
|
| Hospital Charge Code |
2964170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.13 |
| Max. Negotiated Rate |
$510.93 |
| Rate for Payer: Aetna Commercial |
$499.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| 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: Health EOS Commercial |
$494.27
|
| Rate for Payer: HFN Commercial |
$510.93
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: Preferred Network Access Commercial |
$510.93
|
| Rate for Payer: Quartz Beloit One Network |
$272.13
|
| Rate for Payer: Quartz Commercial |
$333.22
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$411.34
|
|
|
BLADE CRESCENT STR 8065990001
|
Facility
|
OP
|
$534.00
|
|
| Hospital Charge Code |
2964170
|
|
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
|
|
|
BLADE DERMATOME 8800-000-10
|
Facility
|
IP
|
$748.00
|
|
| Hospital Charge Code |
2967410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$466.75
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
BLADE DERMATOME 8800-000-10
|
Facility
|
OP
|
$748.00
|
|
| Hospital Charge Code |
2967410
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.82 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Aetna Managed Medicare |
$217.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.34
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.44
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: NAPHCARE Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$505.65
|
| Rate for Payer: Quartz Medicare Advantage |
$466.75
|
| Rate for Payer: The Alliance Commercial |
$388.96
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
BLADE DISP MCGRATH SNGL USE #550-008-000
|
Facility
|
OP
|
$484.00
|
|
| Hospital Charge Code |
2973713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
BLADE DISP MCGRATH SNGL USE #550-008-000
|
Facility
|
IP
|
$484.00
|
|
| Hospital Charge Code |
2973713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
BLADE EXPLANT 52MM LONG(FULL)
|
Facility
|
OP
|
$6,407.00
|
|
| Hospital Charge Code |
2967449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,865.72 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,865.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,331.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,331.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,198.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,728.87
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,997.46
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: NAPHCARE Commercial |
$3,997.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$4,331.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,997.97
|
| Rate for Payer: The Alliance Commercial |
$3,331.64
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
BLADE EXPLANT 52MM LONG(FULL)
|
Facility
|
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2967449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,265.01 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$3,997.97
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
