|
BLADE RIGHT ANGLE BEND 2296-003-109S2
|
Facility
IP
|
$1,008.00
|
|
| Hospital Charge Code |
4194049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.92 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$604.80
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$604.80
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
BLADE RIGHT ANGLE BEND 2296-003-109S2
|
Facility
OP
|
$1,008.00
|
|
| Hospital Charge Code |
4194049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.24 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Aetna Managed Medicare |
$282.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$655.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$504.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$483.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$564.08
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.00
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$604.80
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$655.20
|
| Rate for Payer: Quartz Medicare Advantage |
$604.80
|
| Rate for Payer: The Alliance Commercial |
$4,032.00
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
BLADE SAGITAL 4118-127-090
|
Facility
IP
|
$1,165.00
|
|
| Hospital Charge Code |
2966104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.85 |
| Max. Negotiated Rate |
$1,071.80 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$699.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
BLADE SAGITAL 4118-127-090
|
Facility
OP
|
$1,165.00
|
|
| Hospital Charge Code |
2966104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$4,660.00 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.90
|
| Rate for Payer: Aetna Managed Medicare |
$326.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.93
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.75
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$757.25
|
| Rate for Payer: Quartz Medicare Advantage |
$699.00
|
| Rate for Payer: The Alliance Commercial |
$4,660.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
BLADE SAGITTAL 2108-100-000
|
Facility
OP
|
$2,328.00
|
|
| Hospital Charge Code |
2966103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.84 |
| Max. Negotiated Rate |
$9,312.00 |
| Rate for Payer: Aetna Commercial |
$2,095.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,002.08
|
| Rate for Payer: Aetna Managed Medicare |
$651.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,513.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,117.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,233.84
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$2,141.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,302.75
|
| Rate for Payer: Health EOS Commercial |
$2,071.92
|
| Rate for Payer: HFN Commercial |
$2,141.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,746.00
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,396.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,141.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.72
|
| Rate for Payer: Quartz Commercial |
$1,513.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,396.80
|
| Rate for Payer: The Alliance Commercial |
$9,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,280.40
|
| Rate for Payer: WPS Commercial |
$1,724.35
|
|
|
BLADE SAGITTAL 2108-100-000
|
Facility
IP
|
$2,328.00
|
|
| Hospital Charge Code |
2966103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,140.72 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$2,095.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,233.84
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$2,141.76
|
| Rate for Payer: Health EOS Commercial |
$2,071.92
|
| Rate for Payer: HFN Commercial |
$2,141.76
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,396.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,141.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.72
|
| Rate for Payer: Quartz Commercial |
$1,396.80
|
| Rate for Payer: WEA Trust Commercial |
$1,280.40
|
| Rate for Payer: WPS Commercial |
$1,724.35
|
|
|
BLADE SAGITTAL 6118-127-090
|
Facility
IP
|
$1,165.00
|
|
| Hospital Charge Code |
2966105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.85 |
| Max. Negotiated Rate |
$1,071.80 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$699.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
BLADE SAGITTAL 6118-127-090
|
Facility
OP
|
$1,165.00
|
|
| Hospital Charge Code |
2966105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$4,660.00 |
| Rate for Payer: Aetna Commercial |
$1,048.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.90
|
| Rate for Payer: Aetna Managed Medicare |
$326.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.45
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,071.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.93
|
| Rate for Payer: Health EOS Commercial |
$1,036.85
|
| Rate for Payer: HFN Commercial |
$1,071.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.75
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: NAPHCARE Commercial |
$699.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.80
|
| Rate for Payer: Quartz Beloit One Network |
$570.85
|
| Rate for Payer: Quartz Commercial |
$757.25
|
| Rate for Payer: Quartz Medicare Advantage |
$699.00
|
| Rate for Payer: The Alliance Commercial |
$4,660.00
|
| Rate for Payer: WEA Trust Commercial |
$640.75
|
| Rate for Payer: WPS Commercial |
$862.92
|
|
|
BLADE SAGITTAL DUAL CUT 11.0 X 1.07 X 90MM 4111-119-090
|
Facility
IP
|
$732.00
|
|
| Hospital Charge Code |
6174502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$439.20
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
BLADE SAGITTAL DUAL CUT 11.0 X 1.07 X 90MM 4111-119-090
|
Facility
OP
|
$732.00
|
|
| Hospital Charge Code |
6174502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.96 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Aetna Managed Medicare |
$204.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.63
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.00
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$475.80
|
| Rate for Payer: Quartz Medicare Advantage |
$439.20
|
| Rate for Payer: The Alliance Commercial |
$2,928.00
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
BLADE SAGITTAL PRECISION 13.0 X 1.19 X 90MM 6113-119-090
|
Facility
OP
|
$1,044.00
|
|
| Hospital Charge Code |
5459193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| Rate for Payer: Aetna Managed Medicare |
$292.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.22
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.00
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$678.60
|
| Rate for Payer: Quartz Medicare Advantage |
$626.40
|
| Rate for Payer: The Alliance Commercial |
$4,176.00
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
BLADE SAGITTAL PRECISION 13.0 X 1.19 X 90MM 6113-119-090
|
Facility
IP
|
$1,044.00
|
|
| Hospital Charge Code |
5459193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.56 |
| Max. Negotiated Rate |
$960.48 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$626.40
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
BLADE SAGITTAL PRECISION 25.0 X 1.19 X 90MM 6125-119-090
|
Facility
IP
|
$1,044.00
|
|
| Hospital Charge Code |
5459195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.56 |
| Max. Negotiated Rate |
$960.48 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$626.40
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
BLADE SAGITTAL PRECISION 25.0 X 1.19 X 90MM 6125-119-090
|
Facility
OP
|
$1,044.00
|
|
| Hospital Charge Code |
5459195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| Rate for Payer: Aetna Managed Medicare |
$292.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.22
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.00
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$678.60
|
| Rate for Payer: Quartz Medicare Advantage |
$626.40
|
| Rate for Payer: The Alliance Commercial |
$4,176.00
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
BLADE SAGITTAL PRECISION 25.0 X 1.27 X 90MM 6125-127-090
|
Facility
OP
|
$1,044.00
|
|
| Hospital Charge Code |
5459194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| Rate for Payer: Aetna Managed Medicare |
$292.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.22
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.00
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$678.60
|
| Rate for Payer: Quartz Medicare Advantage |
$626.40
|
| Rate for Payer: The Alliance Commercial |
$4,176.00
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
BLADE SAGITTAL PRECISION 25.0 X 1.27 X 90MM 6125-127-090
|
Facility
IP
|
$1,044.00
|
|
| Hospital Charge Code |
5459194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.56 |
| Max. Negotiated Rate |
$960.48 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$626.40
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
BLADE SAGITTAL SAW PRECISION 13.0 X 1.07 X 90MM 6113-107-090
|
Facility
OP
|
$880.00
|
|
| Hospital Charge Code |
5521013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Aetna Commercial |
$792.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.80
|
| Rate for Payer: Aetna Managed Medicare |
$246.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$572.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$440.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$422.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.40
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$809.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.45
|
| Rate for Payer: Health EOS Commercial |
$783.20
|
| Rate for Payer: HFN Commercial |
$809.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.00
|
| Rate for Payer: Multiplan Commercial |
$704.00
|
| Rate for Payer: NAPHCARE Commercial |
$528.00
|
| Rate for Payer: Preferred Network Access Commercial |
$809.60
|
| Rate for Payer: Quartz Beloit One Network |
$431.20
|
| Rate for Payer: Quartz Commercial |
$572.00
|
| Rate for Payer: Quartz Medicare Advantage |
$528.00
|
| Rate for Payer: The Alliance Commercial |
$3,520.00
|
| Rate for Payer: WEA Trust Commercial |
$484.00
|
| Rate for Payer: WPS Commercial |
$651.82
|
|
|
BLADE SAGITTAL SAW PRECISION 13.0 X 1.07 X 90MM 6113-107-090
|
Facility
IP
|
$880.00
|
|
| Hospital Charge Code |
5521013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$809.60 |
| Rate for Payer: Aetna Commercial |
$792.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.40
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$809.60
|
| Rate for Payer: Health EOS Commercial |
$783.20
|
| Rate for Payer: HFN Commercial |
$809.60
|
| Rate for Payer: Multiplan Commercial |
$704.00
|
| Rate for Payer: NAPHCARE Commercial |
$528.00
|
| Rate for Payer: Preferred Network Access Commercial |
$809.60
|
| Rate for Payer: Quartz Beloit One Network |
$431.20
|
| Rate for Payer: Quartz Commercial |
$528.00
|
| Rate for Payer: WEA Trust Commercial |
$484.00
|
| Rate for Payer: WPS Commercial |
$651.82
|
|
|
BLADE SAGITTAL SAW PRECISION 13.0 X 1.19 X 70MM 6213-119-070
|
Facility
IP
|
$715.00
|
|
| Hospital Charge Code |
6190962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.35 |
| Max. Negotiated Rate |
$657.80 |
| Rate for Payer: Aetna Commercial |
$643.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.95
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$657.80
|
| Rate for Payer: Health EOS Commercial |
$636.35
|
| Rate for Payer: HFN Commercial |
$657.80
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: NAPHCARE Commercial |
$429.00
|
| Rate for Payer: Preferred Network Access Commercial |
$657.80
|
| Rate for Payer: Quartz Beloit One Network |
$350.35
|
| Rate for Payer: Quartz Commercial |
$429.00
|
| Rate for Payer: WEA Trust Commercial |
$393.25
|
| Rate for Payer: WPS Commercial |
$529.60
|
|
|
BLADE SAGITTAL SAW PRECISION 13.0 X 1.19 X 70MM 6213-119-070
|
Facility
OP
|
$715.00
|
|
| Hospital Charge Code |
6190962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$2,860.00 |
| Rate for Payer: Aetna Commercial |
$643.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.90
|
| Rate for Payer: Aetna Managed Medicare |
$200.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.95
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$657.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.11
|
| Rate for Payer: Health EOS Commercial |
$636.35
|
| Rate for Payer: HFN Commercial |
$657.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.25
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: NAPHCARE Commercial |
$429.00
|
| Rate for Payer: Preferred Network Access Commercial |
$657.80
|
| Rate for Payer: Quartz Beloit One Network |
$350.35
|
| Rate for Payer: Quartz Commercial |
$464.75
|
| Rate for Payer: Quartz Medicare Advantage |
$429.00
|
| Rate for Payer: The Alliance Commercial |
$2,860.00
|
| Rate for Payer: WEA Trust Commercial |
$393.25
|
| Rate for Payer: WPS Commercial |
$529.60
|
|
|
BLADE SAW PROFIX 2000 71512901
|
Facility
IP
|
$1,539.00
|
|
| Hospital Charge Code |
2965978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
BLADE SAW PROFIX 2000 71512901
|
Facility
OP
|
$1,539.00
|
|
| Hospital Charge Code |
2965978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
BLADE SAW STERNOTOMY REPEAT 5071-228
|
Facility
OP
|
$665.00
|
|
| Hospital Charge Code |
2964874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Aetna Managed Medicare |
$186.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.13
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$399.00
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$432.25
|
| Rate for Payer: Quartz Medicare Advantage |
$399.00
|
| Rate for Payer: The Alliance Commercial |
$2,660.00
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
BLADE SAW STERNOTOMY REPEAT 5071-228
|
Facility
IP
|
$665.00
|
|
| Hospital Charge Code |
2964874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$399.00
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$399.00
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
BLADE SPIRAL 42MM TITANIUM
|
Facility
OP
|
$6,224.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.72 |
| Max. Negotiated Rate |
$5,726.08 |
| Rate for Payer: Aetna Commercial |
$5,601.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,112.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.72
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,726.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.95
|
| Rate for Payer: Health EOS Commercial |
$5,539.36
|
| Rate for Payer: HFN Commercial |
$5,726.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,668.00
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,726.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.76
|
| Rate for Payer: Quartz Commercial |
$4,045.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.40
|
| Rate for Payer: WEA Trust Commercial |
$3,423.20
|
| Rate for Payer: WPS Commercial |
$4,610.12
|
|
