|
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
|
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: 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 1.27 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 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: Aetna Gatekeeper/Not Gatekeeper |
$756.80
|
| 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 1.07 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 1.19 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: Aetna Gatekeeper/Not Gatekeeper |
$614.90
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| 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
|
IP
|
$6,224.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,049.76 |
| 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: 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: Health EOS Commercial |
$5,539.36
|
| Rate for Payer: HFN Commercial |
$5,726.08
|
| 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 |
$3,734.40
|
| Rate for Payer: WEA Trust Commercial |
$3,423.20
|
| Rate for Payer: WPS Commercial |
$4,610.12
|
|
|
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 |
$24,896.00 |
| 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: The Alliance Commercial |
$24,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,423.20
|
| Rate for Payer: WPS Commercial |
$4,610.12
|
|
|
BLADE STERNUM REVISION SAGITTAL SAFEDGE 2108-125-000
|
Facility
|
IP
|
$843.00
|
|
| Hospital Charge Code |
4519117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.07 |
| Max. Negotiated Rate |
$775.56 |
| Rate for Payer: Aetna Commercial |
$758.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.79
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$775.56
|
| Rate for Payer: Health EOS Commercial |
$750.27
|
| Rate for Payer: HFN Commercial |
$775.56
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: NAPHCARE Commercial |
$505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.56
|
| Rate for Payer: Quartz Beloit One Network |
$413.07
|
| Rate for Payer: Quartz Commercial |
$505.80
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
BLADE STERNUM REVISION SAGITTAL SAFEDGE 2108-125-000
|
Facility
|
OP
|
$843.00
|
|
| Hospital Charge Code |
4519117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.04 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$758.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.98
|
| Rate for Payer: Aetna Managed Medicare |
$236.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.79
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$775.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.74
|
| Rate for Payer: Health EOS Commercial |
$750.27
|
| Rate for Payer: HFN Commercial |
$775.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.25
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: NAPHCARE Commercial |
$505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.56
|
| Rate for Payer: Quartz Beloit One Network |
$413.07
|
| Rate for Payer: Quartz Commercial |
$547.95
|
| Rate for Payer: Quartz Medicare Advantage |
$505.80
|
| Rate for Payer: The Alliance Commercial |
$3,372.00
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
BLADE STERNUM SAW 5059-532
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
2965526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$91.80
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
BLADE STERNUM SAW 5059-532
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
2965526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
BLADE STERNUM SAW STRYKER 298-97-100
|
Facility
|
OP
|
$541.00
|
|
| Hospital Charge Code |
4518781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.48 |
| Max. Negotiated Rate |
$2,164.00 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Aetna Managed Medicare |
$151.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.74
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.75
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$351.65
|
| Rate for Payer: Quartz Medicare Advantage |
$324.60
|
| Rate for Payer: The Alliance Commercial |
$2,164.00
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
BLADE STERNUM SAW STRYKER 298-97-100
|
Facility
|
IP
|
$541.00
|
|
| Hospital Charge Code |
4518781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.09 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$324.60
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
BLADE TENDON STRIPPER 10MM AR-2385-10
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5563609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
BLADE TENDON STRIPPER 10MM AR-2385-10
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5563609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE 73-1191
|
Facility
|
IP
|
$3,140.00
|
|
| Hospital Charge Code |
5349393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,538.60 |
| Max. Negotiated Rate |
$2,888.80 |
| Rate for Payer: Aetna Commercial |
$2,826.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,700.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,664.20
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$2,888.80
|
| Rate for Payer: Health EOS Commercial |
$2,794.60
|
| Rate for Payer: HFN Commercial |
$2,888.80
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,884.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,888.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.60
|
| Rate for Payer: Quartz Commercial |
$1,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,727.00
|
| Rate for Payer: WPS Commercial |
$2,325.80
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE 73-1191
|
Facility
|
OP
|
$3,140.00
|
|
| Hospital Charge Code |
5349393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$12,560.00 |
| Rate for Payer: Aetna Commercial |
$2,826.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,700.40
|
| Rate for Payer: Aetna Managed Medicare |
$879.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,041.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,570.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,664.20
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$2,888.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,757.14
|
| Rate for Payer: Health EOS Commercial |
$2,794.60
|
| Rate for Payer: HFN Commercial |
$2,888.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,355.00
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,884.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,888.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.60
|
| Rate for Payer: Quartz Commercial |
$2,041.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,884.00
|
| Rate for Payer: The Alliance Commercial |
$12,560.00
|
| Rate for Payer: WEA Trust Commercial |
$1,727.00
|
| Rate for Payer: WPS Commercial |
$2,325.80
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE STANDARD 73-1194
|
Facility
|
OP
|
$1,664.00
|
|
| Hospital Charge Code |
5659737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$6,656.00 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$465.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.17
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$998.40
|
| Rate for Payer: The Alliance Commercial |
$6,656.00
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
BLADE ZDRIVE HIGH TORQUE POWER DRIVE STANDARD 73-1194
|
Facility
|
IP
|
$1,664.00
|
|
| Hospital Charge Code |
5659737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
