|
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
|
|
|
BLADE PLASMABLADE PEAK 3.0FR PS210-030S
|
Facility
|
OP
|
$4,791.00
|
|
| Hospital Charge Code |
5459838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,395.14 |
| Max. Negotiated Rate |
$4,584.03 |
| Rate for Payer: Aetna Commercial |
$4,484.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,285.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,238.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,491.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,391.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,640.80
|
| Rate for Payer: Cash Price |
$1,437.30
|
| Rate for Payer: Cigna Commercial |
$4,584.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,788.36
|
| Rate for Payer: Health EOS Commercial |
$4,434.55
|
| Rate for Payer: HFN Commercial |
$4,584.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,736.98
|
| Rate for Payer: Multiplan Commercial |
$3,986.11
|
| Rate for Payer: NAPHCARE Commercial |
$2,989.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,584.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,441.49
|
| Rate for Payer: Quartz Commercial |
$3,238.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,989.58
|
| Rate for Payer: The Alliance Commercial |
$2,491.32
|
| Rate for Payer: WEA Trust Commercial |
$2,740.45
|
| Rate for Payer: WPS Commercial |
$3,690.51
|
|
|
BLADE PLASMABLADE PEAK 3.0FR PS210-030S
|
Facility
|
IP
|
$4,791.00
|
|
| Hospital Charge Code |
5459838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,441.49 |
| Max. Negotiated Rate |
$4,584.03 |
| Rate for Payer: Aetna Commercial |
$4,484.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,285.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,640.80
|
| Rate for Payer: Cash Price |
$1,437.30
|
| Rate for Payer: Cigna Commercial |
$4,584.03
|
| Rate for Payer: Health EOS Commercial |
$4,434.55
|
| Rate for Payer: HFN Commercial |
$4,584.03
|
| Rate for Payer: Multiplan Commercial |
$3,986.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,584.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,441.49
|
| Rate for Payer: Quartz Commercial |
$2,989.58
|
| Rate for Payer: WEA Trust Commercial |
$2,740.45
|
| Rate for Payer: WPS Commercial |
$3,690.51
|
|
|
BLADE PRECISION FALCON OSC SAW 105MM 6725-127-105
|
Facility
|
OP
|
$2,775.00
|
|
| Hospital Charge Code |
4494459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$808.08 |
| Max. Negotiated Rate |
$2,655.12 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Aetna Managed Medicare |
$808.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,875.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,385.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,529.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,655.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,615.05
|
| Rate for Payer: Health EOS Commercial |
$2,568.54
|
| Rate for Payer: HFN Commercial |
$2,655.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,164.50
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,731.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.14
|
| Rate for Payer: Quartz Commercial |
$1,875.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,731.60
|
| Rate for Payer: The Alliance Commercial |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
BLADE PRECISION FALCON OSC SAW 105MM 6725-127-105
|
Facility
|
IP
|
$2,775.00
|
|
| Hospital Charge Code |
4494459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,414.14 |
| Max. Negotiated Rate |
$2,655.12 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,529.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,655.12
|
| Rate for Payer: Health EOS Commercial |
$2,568.54
|
| Rate for Payer: HFN Commercial |
$2,655.12
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.14
|
| Rate for Payer: Quartz Commercial |
$1,731.60
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
BLADE PRECISION THIN 5.5X0.38X11.5MM 2296-003-410
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
5591258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Aetna Managed Medicare |
$169.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.31
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.74
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: NAPHCARE Commercial |
$363.79
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$394.11
|
| Rate for Payer: Quartz Medicare Advantage |
$363.79
|
| Rate for Payer: The Alliance Commercial |
$303.16
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
BLADE PRECISION THIN 5.5X0.38X11.5MM 2296-003-410
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
5591258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$363.79
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
BLADE PRECISION THIN 7.0X0.38X18.5MM 2296-003-114
|
Facility
|
OP
|
$705.00
|
|
| Hospital Charge Code |
5459192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.30 |
| Max. Negotiated Rate |
$674.54 |
| Rate for Payer: Aetna Commercial |
$659.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$630.55
|
| Rate for Payer: Aetna Managed Medicare |
$205.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$476.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.60
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$674.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.31
|
| Rate for Payer: Health EOS Commercial |
$652.55
|
| Rate for Payer: HFN Commercial |
$674.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.90
|
| Rate for Payer: Multiplan Commercial |
$586.56
|
| Rate for Payer: NAPHCARE Commercial |
$439.92
|
| Rate for Payer: Preferred Network Access Commercial |
$674.54
|
| Rate for Payer: Quartz Beloit One Network |
$359.27
|
| Rate for Payer: Quartz Commercial |
$476.58
|
| Rate for Payer: Quartz Medicare Advantage |
$439.92
|
| Rate for Payer: The Alliance Commercial |
$366.60
|
| Rate for Payer: WEA Trust Commercial |
$403.26
|
| Rate for Payer: WPS Commercial |
$543.06
|
|
|
BLADE PRECISION THIN 7.0X0.38X18.5MM 2296-003-114
|
Facility
|
IP
|
$705.00
|
|
| Hospital Charge Code |
5459192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.27 |
| Max. Negotiated Rate |
$674.54 |
| Rate for Payer: Aetna Commercial |
$659.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$630.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.60
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$674.54
|
| Rate for Payer: Health EOS Commercial |
$652.55
|
| Rate for Payer: HFN Commercial |
$674.54
|
| Rate for Payer: Multiplan Commercial |
$586.56
|
| Rate for Payer: Preferred Network Access Commercial |
$674.54
|
| Rate for Payer: Quartz Beloit One Network |
$359.27
|
| Rate for Payer: Quartz Commercial |
$439.92
|
| Rate for Payer: WEA Trust Commercial |
$403.26
|
| Rate for Payer: WPS Commercial |
$543.06
|
|
|
BLADE PRECISION THIN 9.0X0.38X31.0MM 2296-003-255
|
Facility
|
IP
|
$732.00
|
|
| Hospital Charge Code |
5459191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$700.38 |
| Rate for Payer: Aetna Commercial |
$685.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.48
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$700.38
|
| Rate for Payer: Health EOS Commercial |
$677.54
|
| Rate for Payer: HFN Commercial |
$700.38
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: Preferred Network Access Commercial |
$700.38
|
| Rate for Payer: Quartz Beloit One Network |
$373.03
|
| Rate for Payer: Quartz Commercial |
$456.77
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$563.86
|
|
|
BLADE PRECISION THIN 9.0X0.38X31.0MM 2296-003-255
|
Facility
|
OP
|
$732.00
|
|
| Hospital Charge Code |
5459191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$700.38 |
| Rate for Payer: Aetna Commercial |
$685.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Aetna Managed Medicare |
$213.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.48
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$700.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.02
|
| Rate for Payer: Health EOS Commercial |
$677.54
|
| Rate for Payer: HFN Commercial |
$700.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.96
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: NAPHCARE Commercial |
$456.77
|
| Rate for Payer: Preferred Network Access Commercial |
$700.38
|
| Rate for Payer: Quartz Beloit One Network |
$373.03
|
| Rate for Payer: Quartz Commercial |
$494.83
|
| Rate for Payer: Quartz Medicare Advantage |
$456.77
|
| Rate for Payer: The Alliance Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$563.86
|
|
|
BLADE PRO-TOE VO 3.2X16MM 0DEG
|
Facility
|
OP
|
$5,995.00
|
|
| Hospital Charge Code |
3072448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,745.74 |
| Max. Negotiated Rate |
$5,736.02 |
| Rate for Payer: Aetna Commercial |
$5,611.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,361.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,745.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,052.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,117.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,992.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,304.44
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,736.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,489.09
|
| Rate for Payer: Health EOS Commercial |
$5,548.97
|
| Rate for Payer: HFN Commercial |
$5,736.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,676.10
|
| Rate for Payer: Multiplan Commercial |
$4,987.84
|
| Rate for Payer: NAPHCARE Commercial |
$3,740.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,736.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,055.05
|
| Rate for Payer: Quartz Commercial |
$4,052.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,740.88
|
| Rate for Payer: The Alliance Commercial |
$3,117.40
|
| Rate for Payer: WEA Trust Commercial |
$3,429.14
|
| Rate for Payer: WPS Commercial |
$4,617.95
|
|
|
BLADE PRO-TOE VO 3.2X16MM 0DEG
|
Facility
|
IP
|
$5,995.00
|
|
| Hospital Charge Code |
3072448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,055.05 |
| Max. Negotiated Rate |
$5,736.02 |
| Rate for Payer: Aetna Commercial |
$5,611.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,361.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,304.44
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,736.02
|
| Rate for Payer: Health EOS Commercial |
$5,548.97
|
| Rate for Payer: HFN Commercial |
$5,736.02
|
| Rate for Payer: Multiplan Commercial |
$4,987.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,736.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,055.05
|
| Rate for Payer: Quartz Commercial |
$3,740.88
|
| Rate for Payer: WEA Trust Commercial |
$3,429.14
|
| Rate for Payer: WPS Commercial |
$4,617.95
|
|
|
BLADE QUADCUT 4MM X 13CM ROTATE 1884380EM
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
3157472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,961.96 |
| Max. Negotiated Rate |
$3,683.68 |
| Rate for Payer: Aetna Commercial |
$3,603.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,443.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,122.12
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$3,683.68
|
| Rate for Payer: Health EOS Commercial |
$3,563.56
|
| Rate for Payer: HFN Commercial |
$3,683.68
|
| Rate for Payer: Multiplan Commercial |
$3,203.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,683.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,961.96
|
| Rate for Payer: Quartz Commercial |
$2,402.40
|
| Rate for Payer: WEA Trust Commercial |
$2,202.20
|
| Rate for Payer: WPS Commercial |
$2,965.66
|
|
|
BLADE QUADCUT 4MM X 13CM ROTATE 1884380EM
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
3157472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$3,683.68 |
| Rate for Payer: Aetna Commercial |
$3,603.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,443.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,121.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,602.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,002.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,921.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,122.12
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$3,683.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,240.70
|
| Rate for Payer: Health EOS Commercial |
$3,563.56
|
| Rate for Payer: HFN Commercial |
$3,683.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,003.00
|
| Rate for Payer: Multiplan Commercial |
$3,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,683.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,961.96
|
| Rate for Payer: Quartz Commercial |
$2,602.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,402.40
|
| Rate for Payer: The Alliance Commercial |
$2,002.00
|
| Rate for Payer: WEA Trust Commercial |
$2,202.20
|
| Rate for Payer: WPS Commercial |
$2,965.66
|
|
|
BLADE RAD40 4MM ROTATE 1884006EM
|
Facility
|
OP
|
$3,581.00
|
|
| Hospital Charge Code |
3157467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.79 |
| Max. Negotiated Rate |
$3,426.30 |
| Rate for Payer: Aetna Commercial |
$3,351.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,042.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,420.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,862.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,787.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.85
|
| Rate for Payer: Cash Price |
$1,074.30
|
| Rate for Payer: Cigna Commercial |
$3,426.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,084.14
|
| Rate for Payer: Health EOS Commercial |
$3,314.57
|
| Rate for Payer: HFN Commercial |
$3,426.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,793.18
|
| Rate for Payer: Multiplan Commercial |
$2,979.39
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.88
|
| Rate for Payer: Quartz Commercial |
$2,420.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,234.54
|
| Rate for Payer: The Alliance Commercial |
$1,862.12
|
| Rate for Payer: WEA Trust Commercial |
$2,048.33
|
| Rate for Payer: WPS Commercial |
$2,758.44
|
|
|
BLADE RAD40 4MM ROTATE 1884006EM
|
Facility
|
IP
|
$3,581.00
|
|
| Hospital Charge Code |
3157467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,824.88 |
| Max. Negotiated Rate |
$3,426.30 |
| Rate for Payer: Aetna Commercial |
$3,351.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.85
|
| Rate for Payer: Cash Price |
$1,074.30
|
| Rate for Payer: Cigna Commercial |
$3,426.30
|
| Rate for Payer: Health EOS Commercial |
$3,314.57
|
| Rate for Payer: HFN Commercial |
$3,426.30
|
| Rate for Payer: Multiplan Commercial |
$2,979.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.88
|
| Rate for Payer: Quartz Commercial |
$2,234.54
|
| Rate for Payer: WEA Trust Commercial |
$2,048.33
|
| Rate for Payer: WPS Commercial |
$2,758.44
|
|
|
BLADE RAD40 CURVED 1884006HR
|
Facility
|
OP
|
$1,986.00
|
|
| Hospital Charge Code |
2965309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.32 |
| Max. Negotiated Rate |
$1,900.20 |
| Rate for Payer: Aetna Commercial |
$1,858.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,776.28
|
| Rate for Payer: Aetna Managed Medicare |
$578.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,342.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,032.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$991.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.68
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,900.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,155.85
|
| Rate for Payer: Health EOS Commercial |
$1,838.24
|
| Rate for Payer: HFN Commercial |
$1,900.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,549.08
|
| Rate for Payer: Multiplan Commercial |
$1,652.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,239.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,012.07
|
| Rate for Payer: Quartz Commercial |
$1,342.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,239.26
|
| Rate for Payer: The Alliance Commercial |
$1,032.72
|
| Rate for Payer: WEA Trust Commercial |
$1,135.99
|
| Rate for Payer: WPS Commercial |
$1,529.82
|
|
|
BLADE RAD40 CURVED 1884006HR
|
Facility
|
IP
|
$1,986.00
|
|
| Hospital Charge Code |
2965309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,012.07 |
| Max. Negotiated Rate |
$1,900.20 |
| Rate for Payer: Aetna Commercial |
$1,858.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,776.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.68
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,900.20
|
| Rate for Payer: Health EOS Commercial |
$1,838.24
|
| Rate for Payer: HFN Commercial |
$1,900.20
|
| Rate for Payer: Multiplan Commercial |
$1,652.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,012.07
|
| Rate for Payer: Quartz Commercial |
$1,239.26
|
| Rate for Payer: WEA Trust Commercial |
$1,135.99
|
| Rate for Payer: WPS Commercial |
$1,529.82
|
|
|
BLADE RADENOID 4MM 1884008
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
3683500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$2,511.60 |
| Rate for Payer: Aetna Commercial |
$2,457.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,347.80
|
| Rate for Payer: Aetna Managed Medicare |
$764.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,774.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,310.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,446.90
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$2,511.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,527.75
|
| Rate for Payer: Health EOS Commercial |
$2,429.70
|
| Rate for Payer: HFN Commercial |
$2,511.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,638.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,511.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,337.70
|
| Rate for Payer: Quartz Commercial |
$1,774.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,638.00
|
| Rate for Payer: The Alliance Commercial |
$1,365.00
|
| Rate for Payer: WEA Trust Commercial |
$1,501.50
|
| Rate for Payer: WPS Commercial |
$2,022.04
|
|
|
BLADE RADENOID 4MM 1884008
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
3683500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,337.70 |
| Max. Negotiated Rate |
$2,511.60 |
| Rate for Payer: Aetna Commercial |
$2,457.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,347.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,446.90
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$2,511.60
|
| Rate for Payer: Health EOS Commercial |
$2,429.70
|
| Rate for Payer: HFN Commercial |
$2,511.60
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,511.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,337.70
|
| Rate for Payer: Quartz Commercial |
$1,638.00
|
| Rate for Payer: WEA Trust Commercial |
$1,501.50
|
| Rate for Payer: WPS Commercial |
$2,022.04
|
|
|
BLADE RECIPROCATING DOUBLE SIDED 277-096-276
|
Facility
|
IP
|
$917.00
|
|
| Hospital Charge Code |
2966102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.30 |
| Max. Negotiated Rate |
$877.39 |
| Rate for Payer: Aetna Commercial |
$858.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.45
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$877.39
|
| Rate for Payer: Health EOS Commercial |
$848.78
|
| Rate for Payer: HFN Commercial |
$877.39
|
| Rate for Payer: Multiplan Commercial |
$762.94
|
| Rate for Payer: Preferred Network Access Commercial |
$877.39
|
| Rate for Payer: Quartz Beloit One Network |
$467.30
|
| Rate for Payer: Quartz Commercial |
$572.21
|
| Rate for Payer: WEA Trust Commercial |
$524.52
|
| Rate for Payer: WPS Commercial |
$706.37
|
|
|
BLADE RECIPROCATING DOUBLE SIDED 277-096-276
|
Facility
|
OP
|
$917.00
|
|
| Hospital Charge Code |
2966102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.03 |
| Max. Negotiated Rate |
$877.39 |
| Rate for Payer: Aetna Commercial |
$858.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.16
|
| Rate for Payer: Aetna Managed Medicare |
$267.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.45
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$877.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.69
|
| Rate for Payer: Health EOS Commercial |
$848.78
|
| Rate for Payer: HFN Commercial |
$877.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.26
|
| Rate for Payer: Multiplan Commercial |
$762.94
|
| Rate for Payer: NAPHCARE Commercial |
$572.21
|
| Rate for Payer: Preferred Network Access Commercial |
$877.39
|
| Rate for Payer: Quartz Beloit One Network |
$467.30
|
| Rate for Payer: Quartz Commercial |
$619.89
|
| Rate for Payer: Quartz Medicare Advantage |
$572.21
|
| Rate for Payer: The Alliance Commercial |
$476.84
|
| Rate for Payer: WEA Trust Commercial |
$524.52
|
| Rate for Payer: WPS Commercial |
$706.37
|
|
|
BLADE RIGHT ANGLE BEND 2296-003-109S2
|
Facility
|
IP
|
$1,008.00
|
|
| Hospital Charge Code |
4194049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$964.45 |
| Rate for Payer: Aetna Commercial |
$943.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.61
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$964.45
|
| Rate for Payer: Health EOS Commercial |
$933.00
|
| Rate for Payer: HFN Commercial |
$964.45
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: Preferred Network Access Commercial |
$964.45
|
| Rate for Payer: Quartz Beloit One Network |
$513.68
|
| Rate for Payer: Quartz Commercial |
$628.99
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: WPS Commercial |
$776.46
|
|
|
BLADE RIGHT ANGLE BEND 2296-003-109S2
|
Facility
|
OP
|
$1,008.00
|
|
| Hospital Charge Code |
4194049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.53 |
| Max. Negotiated Rate |
$964.45 |
| Rate for Payer: Aetna Commercial |
$943.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Aetna Managed Medicare |
$293.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$524.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$503.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.61
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$964.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.66
|
| Rate for Payer: Health EOS Commercial |
$933.00
|
| Rate for Payer: HFN Commercial |
$964.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$786.24
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: NAPHCARE Commercial |
$628.99
|
| Rate for Payer: Preferred Network Access Commercial |
$964.45
|
| Rate for Payer: Quartz Beloit One Network |
$513.68
|
| Rate for Payer: Quartz Commercial |
$681.41
|
| Rate for Payer: Quartz Medicare Advantage |
$628.99
|
| Rate for Payer: The Alliance Commercial |
$524.16
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: WPS Commercial |
$776.46
|
|
