|
BLADE LONG WIDE 2296-003-106
|
Facility
|
IP
|
$760.00
|
|
| Hospital Charge Code |
3070016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE LONG WIDE 2296-003-106
|
Facility
|
OP
|
$760.00
|
|
| Hospital Charge Code |
3070016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$221.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$474.24
|
| Rate for Payer: The Alliance Commercial |
$395.20
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE MED-LONG 2108-109
|
Facility
|
IP
|
$963.00
|
|
| Hospital Charge Code |
2966106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.74 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$600.91
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
BLADE MED-LONG 2108-109
|
Facility
|
OP
|
$963.00
|
|
| Hospital Charge Code |
2966106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.43 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$280.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.47
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.14
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$600.91
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$650.99
|
| Rate for Payer: Quartz Medicare Advantage |
$600.91
|
| Rate for Payer: The Alliance Commercial |
$500.76
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
BLADE MED MED 18.5 2296-003-105
|
Facility
|
OP
|
$760.00
|
|
| Hospital Charge Code |
3070017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$221.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$474.24
|
| Rate for Payer: The Alliance Commercial |
$395.20
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE MED MED 18.5 2296-003-105
|
Facility
|
IP
|
$760.00
|
|
| Hospital Charge Code |
3070017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
BLADE MIDAS REX LEGEND AF03 F3/9TA30
|
Facility
|
OP
|
$2,034.00
|
|
| Hospital Charge Code |
5349380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.30 |
| Max. Negotiated Rate |
$1,946.13 |
| Rate for Payer: Aetna Commercial |
$1,903.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.21
|
| Rate for Payer: Aetna Managed Medicare |
$592.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.14
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,946.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.79
|
| Rate for Payer: Health EOS Commercial |
$1,882.67
|
| Rate for Payer: HFN Commercial |
$1,946.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.52
|
| Rate for Payer: Multiplan Commercial |
$1,692.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.53
|
| Rate for Payer: Quartz Commercial |
$1,374.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.22
|
| Rate for Payer: The Alliance Commercial |
$1,057.68
|
| Rate for Payer: WEA Trust Commercial |
$1,163.45
|
| Rate for Payer: WPS Commercial |
$1,566.79
|
|
|
BLADE MIDAS REX LEGEND AF03 F3/9TA30
|
Facility
|
IP
|
$2,034.00
|
|
| Hospital Charge Code |
5349380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.53 |
| Max. Negotiated Rate |
$1,946.13 |
| Rate for Payer: Aetna Commercial |
$1,903.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.14
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,946.13
|
| Rate for Payer: Health EOS Commercial |
$1,882.67
|
| Rate for Payer: HFN Commercial |
$1,946.13
|
| Rate for Payer: Multiplan Commercial |
$1,692.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.53
|
| Rate for Payer: Quartz Commercial |
$1,269.22
|
| Rate for Payer: WEA Trust Commercial |
$1,163.45
|
| Rate for Payer: WPS Commercial |
$1,566.79
|
|
|
BLADE MILLER 0 POLARIS 4150001
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963293
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE MILLER 0 POLARIS 4150001
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
2963293
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BLADE MINI 62 12877
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2971253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
BLADE MINI 62 12877
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2971253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
BLADE MYRINGOTOMY MICROEDGE DOUBLE CUTTING EDGE ARROW DISP BL-0150
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
2965296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
BLADE MYRINGOTOMY MICROEDGE DOUBLE CUTTING EDGE ARROW DISP BL-0150
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
2965296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
BLADE OSTEOTOMY SAW HUB STYLE S 80-0740-S
|
Facility
|
IP
|
$1,613.00
|
|
| Hospital Charge Code |
4427963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.98 |
| Max. Negotiated Rate |
$1,543.32 |
| Rate for Payer: Aetna Commercial |
$1,509.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.09
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: Health EOS Commercial |
$1,492.99
|
| Rate for Payer: HFN Commercial |
$1,543.32
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.32
|
| Rate for Payer: Quartz Beloit One Network |
$821.98
|
| Rate for Payer: Quartz Commercial |
$1,006.51
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: WPS Commercial |
$1,242.49
|
|
|
BLADE OSTEOTOMY SAW HUB STYLE S 80-0740-S
|
Facility
|
OP
|
$1,613.00
|
|
| Hospital Charge Code |
4427963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.71 |
| Max. Negotiated Rate |
$1,543.32 |
| Rate for Payer: Aetna Commercial |
$1,509.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Aetna Managed Medicare |
$469.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$838.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.09
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$938.77
|
| Rate for Payer: Health EOS Commercial |
$1,492.99
|
| Rate for Payer: HFN Commercial |
$1,543.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.14
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.32
|
| Rate for Payer: Quartz Beloit One Network |
$821.98
|
| Rate for Payer: Quartz Commercial |
$1,090.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.51
|
| Rate for Payer: The Alliance Commercial |
$838.76
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: WPS Commercial |
$1,242.49
|
|
|
BLADE PACK AM MULTI- PACK AM96BLD5
|
Facility
|
IP
|
$4,450.00
|
|
| Hospital Charge Code |
5729877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,267.72 |
| Max. Negotiated Rate |
$4,257.76 |
| Rate for Payer: Aetna Commercial |
$4,165.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,980.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.84
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$4,257.76
|
| Rate for Payer: Health EOS Commercial |
$4,118.92
|
| Rate for Payer: HFN Commercial |
$4,257.76
|
| Rate for Payer: Multiplan Commercial |
$3,702.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,257.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.72
|
| Rate for Payer: Quartz Commercial |
$2,776.80
|
| Rate for Payer: WEA Trust Commercial |
$2,545.40
|
| Rate for Payer: WPS Commercial |
$3,427.84
|
|
|
BLADE PACK AM MULTI- PACK AM96BLD5
|
Facility
|
OP
|
$4,450.00
|
|
| Hospital Charge Code |
5729877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,295.84 |
| Max. Negotiated Rate |
$4,257.76 |
| Rate for Payer: Aetna Commercial |
$4,165.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,980.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,008.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,314.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,221.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.84
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$4,257.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,589.90
|
| Rate for Payer: Health EOS Commercial |
$4,118.92
|
| Rate for Payer: HFN Commercial |
$4,257.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,471.00
|
| Rate for Payer: Multiplan Commercial |
$3,702.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,257.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.72
|
| Rate for Payer: Quartz Commercial |
$3,008.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,776.80
|
| Rate for Payer: The Alliance Commercial |
$2,314.00
|
| Rate for Payer: WEA Trust Commercial |
$2,545.40
|
| Rate for Payer: WPS Commercial |
$3,427.84
|
|
|
BLADE PACK AM SINGLE PACK AM96BLD1
|
Facility
|
IP
|
$4,596.00
|
|
| Hospital Charge Code |
5685892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,342.12 |
| Max. Negotiated Rate |
$4,397.45 |
| Rate for Payer: Aetna Commercial |
$4,301.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,110.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.32
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$4,397.45
|
| Rate for Payer: Health EOS Commercial |
$4,254.06
|
| Rate for Payer: HFN Commercial |
$4,397.45
|
| Rate for Payer: Multiplan Commercial |
$3,823.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,397.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.12
|
| Rate for Payer: Quartz Commercial |
$2,867.90
|
| Rate for Payer: WEA Trust Commercial |
$2,628.91
|
| Rate for Payer: WPS Commercial |
$3,540.30
|
|
|
BLADE PACK AM SINGLE PACK AM96BLD1
|
Facility
|
OP
|
$4,596.00
|
|
| Hospital Charge Code |
5685892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.36 |
| Max. Negotiated Rate |
$4,397.45 |
| Rate for Payer: Aetna Commercial |
$4,301.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,110.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,106.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,389.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.32
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$4,397.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,674.87
|
| Rate for Payer: Health EOS Commercial |
$4,254.06
|
| Rate for Payer: HFN Commercial |
$4,397.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,584.88
|
| Rate for Payer: Multiplan Commercial |
$3,823.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,867.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,397.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.12
|
| Rate for Payer: Quartz Commercial |
$3,106.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,867.90
|
| Rate for Payer: The Alliance Commercial |
$2,389.92
|
| Rate for Payer: WEA Trust Commercial |
$2,628.91
|
| Rate for Payer: WPS Commercial |
$3,540.30
|
|
|
BLADE PARALLEL GRAFT KNIFE 10MM AR-2285-10
|
Facility
|
IP
|
$876.00
|
|
| Hospital Charge Code |
5563229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.41 |
| Max. Negotiated Rate |
$838.16 |
| Rate for Payer: Aetna Commercial |
$819.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$783.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.85
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$838.16
|
| Rate for Payer: Health EOS Commercial |
$810.83
|
| Rate for Payer: HFN Commercial |
$838.16
|
| Rate for Payer: Multiplan Commercial |
$728.83
|
| Rate for Payer: Preferred Network Access Commercial |
$838.16
|
| Rate for Payer: Quartz Beloit One Network |
$446.41
|
| Rate for Payer: Quartz Commercial |
$546.62
|
| Rate for Payer: WEA Trust Commercial |
$501.07
|
| Rate for Payer: WPS Commercial |
$674.78
|
|
|
BLADE PARALLEL GRAFT KNIFE 10MM AR-2285-10
|
Facility
|
OP
|
$876.00
|
|
| Hospital Charge Code |
5563229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$838.16 |
| Rate for Payer: Aetna Commercial |
$819.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$783.49
|
| Rate for Payer: Aetna Managed Medicare |
$255.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$592.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$455.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$437.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.85
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$838.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.83
|
| Rate for Payer: Health EOS Commercial |
$810.83
|
| Rate for Payer: HFN Commercial |
$838.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$683.28
|
| Rate for Payer: Multiplan Commercial |
$728.83
|
| Rate for Payer: NAPHCARE Commercial |
$546.62
|
| Rate for Payer: Preferred Network Access Commercial |
$838.16
|
| Rate for Payer: Quartz Beloit One Network |
$446.41
|
| Rate for Payer: Quartz Commercial |
$592.18
|
| Rate for Payer: Quartz Medicare Advantage |
$546.62
|
| Rate for Payer: The Alliance Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$501.07
|
| Rate for Payer: WPS Commercial |
$674.78
|
|
|
BLADE PARALLEL GRAFT KNIFE 9MM AR-2285-09
|
Facility
|
IP
|
$876.00
|
|
| Hospital Charge Code |
5496931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.41 |
| Max. Negotiated Rate |
$838.16 |
| Rate for Payer: Aetna Commercial |
$819.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$783.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.85
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$838.16
|
| Rate for Payer: Health EOS Commercial |
$810.83
|
| Rate for Payer: HFN Commercial |
$838.16
|
| Rate for Payer: Multiplan Commercial |
$728.83
|
| Rate for Payer: Preferred Network Access Commercial |
$838.16
|
| Rate for Payer: Quartz Beloit One Network |
$446.41
|
| Rate for Payer: Quartz Commercial |
$546.62
|
| Rate for Payer: WEA Trust Commercial |
$501.07
|
| Rate for Payer: WPS Commercial |
$674.78
|
|
|
BLADE PARALLEL GRAFT KNIFE 9MM AR-2285-09
|
Facility
|
OP
|
$876.00
|
|
| Hospital Charge Code |
5496931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$838.16 |
| Rate for Payer: Aetna Commercial |
$819.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$783.49
|
| Rate for Payer: Aetna Managed Medicare |
$255.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$592.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$455.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$437.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.85
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$838.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.83
|
| Rate for Payer: Health EOS Commercial |
$810.83
|
| Rate for Payer: HFN Commercial |
$838.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$683.28
|
| Rate for Payer: Multiplan Commercial |
$728.83
|
| Rate for Payer: NAPHCARE Commercial |
$546.62
|
| Rate for Payer: Preferred Network Access Commercial |
$838.16
|
| Rate for Payer: Quartz Beloit One Network |
$446.41
|
| Rate for Payer: Quartz Commercial |
$592.18
|
| Rate for Payer: Quartz Medicare Advantage |
$546.62
|
| Rate for Payer: The Alliance Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$501.07
|
| Rate for Payer: WPS Commercial |
$674.78
|
|
|
BLADE PATELLA 2108-383
|
Facility
|
IP
|
$2,328.00
|
|
| Hospital Charge Code |
2966100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,186.35 |
| Max. Negotiated Rate |
$2,227.43 |
| Rate for Payer: Aetna Commercial |
$2,179.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,082.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,283.19
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$2,227.43
|
| Rate for Payer: Health EOS Commercial |
$2,154.80
|
| Rate for Payer: HFN Commercial |
$2,227.43
|
| Rate for Payer: Multiplan Commercial |
$1,936.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,227.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,186.35
|
| Rate for Payer: Quartz Commercial |
$1,452.67
|
| Rate for Payer: WEA Trust Commercial |
$1,331.62
|
| Rate for Payer: WPS Commercial |
$1,793.26
|
|
