|
BLADE PRO-TOE VO 3.2X16MM 0DEG
|
Facility
|
OP
|
$5,995.00
|
|
| Hospital Charge Code |
3072448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,678.60 |
| Max. Negotiated Rate |
$23,980.00 |
| Rate for Payer: Aetna Commercial |
$5,395.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,155.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,678.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,896.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,997.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,877.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,177.35
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,515.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,354.80
|
| Rate for Payer: Health EOS Commercial |
$5,335.55
|
| Rate for Payer: HFN Commercial |
$5,515.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,496.25
|
| Rate for Payer: Multiplan Commercial |
$4,796.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,597.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,515.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,937.55
|
| Rate for Payer: Quartz Commercial |
$3,896.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,597.00
|
| Rate for Payer: The Alliance Commercial |
$23,980.00
|
| Rate for Payer: WEA Trust Commercial |
$3,297.25
|
| Rate for Payer: WPS Commercial |
$4,440.50
|
|
|
BLADE PRO-TOE VO 3.2X16MM 0DEG
|
Facility
|
IP
|
$5,995.00
|
|
| Hospital Charge Code |
3072448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,937.55 |
| Max. Negotiated Rate |
$5,515.40 |
| Rate for Payer: Aetna Commercial |
$5,395.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,155.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,177.35
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,515.40
|
| Rate for Payer: Health EOS Commercial |
$5,335.55
|
| Rate for Payer: HFN Commercial |
$5,515.40
|
| Rate for Payer: Multiplan Commercial |
$4,796.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,597.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,515.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,937.55
|
| Rate for Payer: Quartz Commercial |
$3,597.00
|
| Rate for Payer: WEA Trust Commercial |
$3,297.25
|
| Rate for Payer: WPS Commercial |
$4,440.50
|
|
|
BLADE QUADCUT 4MM X 13CM ROTATE 1884380EM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
3157472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$15,400.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,311.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,078.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,502.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,925.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,848.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,040.50
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$3,542.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,154.46
|
| Rate for Payer: Health EOS Commercial |
$3,426.50
|
| Rate for Payer: HFN Commercial |
$3,542.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,310.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,542.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,886.50
|
| Rate for Payer: Quartz Commercial |
$2,502.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,310.00
|
| Rate for Payer: The Alliance Commercial |
$15,400.00
|
| Rate for Payer: WEA Trust Commercial |
$2,117.50
|
| Rate for Payer: WPS Commercial |
$2,851.70
|
|
|
BLADE QUADCUT 4MM X 13CM ROTATE 1884380EM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
3157472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,886.50 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,311.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,040.50
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$3,542.00
|
| Rate for Payer: Health EOS Commercial |
$3,426.50
|
| Rate for Payer: HFN Commercial |
$3,542.00
|
| Rate for Payer: Multiplan Commercial |
$3,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,310.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,542.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,886.50
|
| Rate for Payer: Quartz Commercial |
$2,310.00
|
| Rate for Payer: WEA Trust Commercial |
$2,117.50
|
| Rate for Payer: WPS Commercial |
$2,851.70
|
|
|
BLADE RAD40 4MM ROTATE 1884006EM
|
Facility
|
OP
|
$3,581.00
|
|
| Hospital Charge Code |
3157467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,002.68 |
| Max. Negotiated Rate |
$14,324.00 |
| Rate for Payer: Aetna Commercial |
$3,222.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,079.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,002.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,327.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,790.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,718.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.93
|
| Rate for Payer: Cash Price |
$1,074.30
|
| Rate for Payer: Cigna Commercial |
$3,294.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,003.93
|
| Rate for Payer: Health EOS Commercial |
$3,187.09
|
| Rate for Payer: HFN Commercial |
$3,294.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,685.75
|
| Rate for Payer: Multiplan Commercial |
$2,864.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,294.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.69
|
| Rate for Payer: Quartz Commercial |
$2,327.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,148.60
|
| Rate for Payer: The Alliance Commercial |
$14,324.00
|
| Rate for Payer: WEA Trust Commercial |
$1,969.55
|
| Rate for Payer: WPS Commercial |
$2,652.45
|
|
|
BLADE RAD40 4MM ROTATE 1884006EM
|
Facility
|
IP
|
$3,581.00
|
|
| Hospital Charge Code |
3157467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,754.69 |
| Max. Negotiated Rate |
$3,294.52 |
| Rate for Payer: Aetna Commercial |
$3,222.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,079.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.93
|
| Rate for Payer: Cash Price |
$1,074.30
|
| Rate for Payer: Cigna Commercial |
$3,294.52
|
| Rate for Payer: Health EOS Commercial |
$3,187.09
|
| Rate for Payer: HFN Commercial |
$3,294.52
|
| Rate for Payer: Multiplan Commercial |
$2,864.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,294.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.69
|
| Rate for Payer: Quartz Commercial |
$2,148.60
|
| Rate for Payer: WEA Trust Commercial |
$1,969.55
|
| Rate for Payer: WPS Commercial |
$2,652.45
|
|
|
BLADE RAD40 CURVED 1884006HR
|
Facility
|
OP
|
$1,986.00
|
|
| Hospital Charge Code |
2965309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.08 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$1,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.96
|
| Rate for Payer: Aetna Managed Medicare |
$556.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,290.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$993.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$953.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.58
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,827.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.37
|
| Rate for Payer: Health EOS Commercial |
$1,767.54
|
| Rate for Payer: HFN Commercial |
$1,827.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,489.50
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.12
|
| Rate for Payer: Quartz Beloit One Network |
$973.14
|
| Rate for Payer: Quartz Commercial |
$1,290.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,191.60
|
| Rate for Payer: The Alliance Commercial |
$7,944.00
|
| Rate for Payer: WEA Trust Commercial |
$1,092.30
|
| Rate for Payer: WPS Commercial |
$1,471.03
|
|
|
BLADE RAD40 CURVED 1884006HR
|
Facility
|
IP
|
$1,986.00
|
|
| Hospital Charge Code |
2965309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$1,827.12 |
| Rate for Payer: Aetna Commercial |
$1,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.58
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,827.12
|
| Rate for Payer: Health EOS Commercial |
$1,767.54
|
| Rate for Payer: HFN Commercial |
$1,827.12
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.12
|
| Rate for Payer: Quartz Beloit One Network |
$973.14
|
| Rate for Payer: Quartz Commercial |
$1,191.60
|
| Rate for Payer: WEA Trust Commercial |
$1,092.30
|
| Rate for Payer: WPS Commercial |
$1,471.03
|
|
|
BLADE RADENOID 4MM 1884008
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
3683500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$10,500.00 |
| Rate for Payer: Aetna Commercial |
$2,362.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.50
|
| Rate for Payer: Aetna Managed Medicare |
$735.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,260.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.25
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$2,415.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.95
|
| Rate for Payer: Health EOS Commercial |
$2,336.25
|
| Rate for Payer: HFN Commercial |
$2,415.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.75
|
| Rate for Payer: Multiplan Commercial |
$2,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,575.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,415.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.25
|
| Rate for Payer: Quartz Commercial |
$1,706.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,575.00
|
| Rate for Payer: The Alliance Commercial |
$10,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,443.75
|
| Rate for Payer: WPS Commercial |
$1,944.34
|
|
|
BLADE RADENOID 4MM 1884008
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
3683500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.25 |
| Max. Negotiated Rate |
$2,415.00 |
| Rate for Payer: Aetna Commercial |
$2,362.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.25
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$2,415.00
|
| Rate for Payer: Health EOS Commercial |
$2,336.25
|
| Rate for Payer: HFN Commercial |
$2,415.00
|
| Rate for Payer: Multiplan Commercial |
$2,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,575.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,415.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.25
|
| Rate for Payer: Quartz Commercial |
$1,575.00
|
| Rate for Payer: WEA Trust Commercial |
$1,443.75
|
| Rate for Payer: WPS Commercial |
$1,944.34
|
|
|
BLADE RECIPROCATING DOUBLE SIDED 277-096-276
|
Facility
|
IP
|
$917.00
|
|
| Hospital Charge Code |
2966102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.33 |
| Max. Negotiated Rate |
$843.64 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$550.20
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
BLADE RECIPROCATING DOUBLE SIDED 277-096-276
|
Facility
|
OP
|
$917.00
|
|
| Hospital Charge Code |
2966102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$3,668.00 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$256.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.15
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$596.05
|
| Rate for Payer: Quartz Medicare Advantage |
$550.20
|
| Rate for Payer: The Alliance Commercial |
$3,668.00
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,001.90
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,002.08
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,001.90
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| 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
|
|
