|
BLADE SAGITAL 4118-127-090
|
Facility
|
IP
|
$1,165.00
|
|
| Hospital Charge Code |
2966104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
BLADE SAGITAL 4118-127-090
|
Facility
|
OP
|
$1,165.00
|
|
| Hospital Charge Code |
2966104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.25 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Aetna Managed Medicare |
$339.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.03
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.70
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: NAPHCARE Commercial |
$726.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$787.54
|
| Rate for Payer: Quartz Medicare Advantage |
$726.96
|
| Rate for Payer: The Alliance Commercial |
$605.80
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
BLADE SAGITTAL 2108-100-000
|
Facility
|
IP
|
$2,328.00
|
|
| Hospital Charge Code |
2966103
|
|
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 SAGITTAL 2108-100-000
|
Facility
|
OP
|
$2,328.00
|
|
| Hospital Charge Code |
2966103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.91 |
| 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: Aetna Managed Medicare |
$677.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,573.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,210.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,162.14
|
| 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: Dean Health DHI/DHP/ASO |
$1,354.90
|
| Rate for Payer: Health EOS Commercial |
$2,154.80
|
| Rate for Payer: HFN Commercial |
$2,227.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,815.84
|
| Rate for Payer: Multiplan Commercial |
$1,936.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,452.67
|
| 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 |
$1,573.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,452.67
|
| Rate for Payer: The Alliance Commercial |
$1,210.56
|
| Rate for Payer: WEA Trust Commercial |
$1,331.62
|
| Rate for Payer: WPS Commercial |
$1,793.26
|
|
|
BLADE SAGITTAL 6118-127-090
|
Facility
|
OP
|
$1,165.00
|
|
| Hospital Charge Code |
2966105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.25 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Aetna Managed Medicare |
$339.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.03
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.70
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: NAPHCARE Commercial |
$726.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$787.54
|
| Rate for Payer: Quartz Medicare Advantage |
$726.96
|
| Rate for Payer: The Alliance Commercial |
$605.80
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
BLADE SAGITTAL 6118-127-090
|
Facility
|
IP
|
$1,165.00
|
|
| Hospital Charge Code |
2966105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
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 |
$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 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 |
$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 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 |
$304.01 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Aetna Managed Medicare |
$304.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.61
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.32
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: NAPHCARE Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$705.74
|
| Rate for Payer: Quartz Medicare Advantage |
$651.46
|
| Rate for Payer: The Alliance Commercial |
$542.88
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
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 |
$532.02 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$651.46
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
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 |
$532.02 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$651.46
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
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 |
$304.01 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Aetna Managed Medicare |
$304.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.61
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.32
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: NAPHCARE Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$705.74
|
| Rate for Payer: Quartz Medicare Advantage |
$651.46
|
| Rate for Payer: The Alliance Commercial |
$542.88
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
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 |
$304.01 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Aetna Managed Medicare |
$304.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.61
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.32
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: NAPHCARE Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$705.74
|
| Rate for Payer: Quartz Medicare Advantage |
$651.46
|
| Rate for Payer: The Alliance Commercial |
$542.88
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
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 |
$532.02 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$651.46
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
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 |
$448.45 |
| Max. Negotiated Rate |
$841.98 |
| Rate for Payer: Aetna Commercial |
$823.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.06
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$841.98
|
| Rate for Payer: Health EOS Commercial |
$814.53
|
| Rate for Payer: HFN Commercial |
$841.98
|
| Rate for Payer: Multiplan Commercial |
$732.16
|
| Rate for Payer: Preferred Network Access Commercial |
$841.98
|
| Rate for Payer: Quartz Beloit One Network |
$448.45
|
| Rate for Payer: Quartz Commercial |
$549.12
|
| Rate for Payer: WEA Trust Commercial |
$503.36
|
| Rate for Payer: WPS Commercial |
$677.86
|
|
|
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 |
$256.26 |
| Max. Negotiated Rate |
$841.98 |
| Rate for Payer: Aetna Commercial |
$823.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.07
|
| Rate for Payer: Aetna Managed Medicare |
$256.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.06
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$841.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.16
|
| Rate for Payer: Health EOS Commercial |
$814.53
|
| Rate for Payer: HFN Commercial |
$841.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.40
|
| Rate for Payer: Multiplan Commercial |
$732.16
|
| Rate for Payer: NAPHCARE Commercial |
$549.12
|
| Rate for Payer: Preferred Network Access Commercial |
$841.98
|
| Rate for Payer: Quartz Beloit One Network |
$448.45
|
| Rate for Payer: Quartz Commercial |
$594.88
|
| Rate for Payer: Quartz Medicare Advantage |
$549.12
|
| Rate for Payer: The Alliance Commercial |
$457.60
|
| Rate for Payer: WEA Trust Commercial |
$503.36
|
| Rate for Payer: WPS Commercial |
$677.86
|
|
|
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 |
$364.36 |
| Max. Negotiated Rate |
$684.11 |
| Rate for Payer: Aetna Commercial |
$669.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$639.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.11
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$684.11
|
| Rate for Payer: Health EOS Commercial |
$661.80
|
| Rate for Payer: HFN Commercial |
$684.11
|
| Rate for Payer: Multiplan Commercial |
$594.88
|
| Rate for Payer: Preferred Network Access Commercial |
$684.11
|
| Rate for Payer: Quartz Beloit One Network |
$364.36
|
| Rate for Payer: Quartz Commercial |
$446.16
|
| Rate for Payer: WEA Trust Commercial |
$408.98
|
| Rate for Payer: WPS Commercial |
$550.76
|
|
|
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 |
$208.21 |
| Max. Negotiated Rate |
$684.11 |
| Rate for Payer: Aetna Commercial |
$669.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$639.50
|
| Rate for Payer: Aetna Managed Medicare |
$208.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$483.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.11
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$684.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.13
|
| Rate for Payer: Health EOS Commercial |
$661.80
|
| Rate for Payer: HFN Commercial |
$684.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$557.70
|
| Rate for Payer: Multiplan Commercial |
$594.88
|
| Rate for Payer: NAPHCARE Commercial |
$446.16
|
| Rate for Payer: Preferred Network Access Commercial |
$684.11
|
| Rate for Payer: Quartz Beloit One Network |
$364.36
|
| Rate for Payer: Quartz Commercial |
$483.34
|
| Rate for Payer: Quartz Medicare Advantage |
$446.16
|
| Rate for Payer: The Alliance Commercial |
$371.80
|
| Rate for Payer: WEA Trust Commercial |
$408.98
|
| Rate for Payer: WPS Commercial |
$550.76
|
|
|
BLADE SAW PROFIX 2000 71512901
|
Facility
|
IP
|
$1,539.00
|
|
| Hospital Charge Code |
2965978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
BLADE SAW PROFIX 2000 71512901
|
Facility
|
OP
|
$1,539.00
|
|
| Hospital Charge Code |
2965978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$800.28
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
BLADE SAW STERNOTOMY REPEAT 5071-228
|
Facility
|
IP
|
$665.00
|
|
| Hospital Charge Code |
2964874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$636.27
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
BLADE SAW STERNOTOMY REPEAT 5071-228
|
Facility
|
OP
|
$665.00
|
|
| Hospital Charge Code |
2964874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.65 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Aetna Managed Medicare |
$193.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$449.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$636.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.03
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: NAPHCARE Commercial |
$414.96
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$449.54
|
| Rate for Payer: Quartz Medicare Advantage |
$414.96
|
| Rate for Payer: The Alliance Commercial |
$345.80
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
BLADE SPIRAL 42MM TITANIUM
|
Facility
|
IP
|
$6,224.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,171.75 |
| Max. Negotiated Rate |
$5,955.12 |
| Rate for Payer: Aetna Commercial |
$5,825.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,566.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,430.67
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,955.12
|
| Rate for Payer: Health EOS Commercial |
$5,760.93
|
| Rate for Payer: HFN Commercial |
$5,955.12
|
| Rate for Payer: Multiplan Commercial |
$5,178.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,955.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,171.75
|
| Rate for Payer: Quartz Commercial |
$3,883.78
|
| Rate for Payer: WEA Trust Commercial |
$3,560.13
|
| Rate for Payer: WPS Commercial |
$4,794.35
|
|
|
BLADE SPIRAL 42MM TITANIUM
|
Facility
|
OP
|
$6,224.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2966153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.43 |
| Max. Negotiated Rate |
$5,955.12 |
| Rate for Payer: Aetna Commercial |
$5,825.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,566.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,812.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,207.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,236.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,107.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,430.67
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,955.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,622.37
|
| Rate for Payer: Health EOS Commercial |
$5,760.93
|
| Rate for Payer: HFN Commercial |
$5,955.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,854.72
|
| Rate for Payer: Multiplan Commercial |
$5,178.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,883.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,955.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,171.75
|
| Rate for Payer: Quartz Commercial |
$4,207.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,883.78
|
| Rate for Payer: The Alliance Commercial |
$3,236.48
|
| Rate for Payer: WEA Trust Commercial |
$3,560.13
|
| Rate for Payer: WPS Commercial |
$4,794.35
|
|
|
BLADE STERNUM REVISION SAGITTAL SAFEDGE 2108-125-000
|
Facility
|
IP
|
$843.00
|
|
| Hospital Charge Code |
4519117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.59 |
| Max. Negotiated Rate |
$806.58 |
| Rate for Payer: Aetna Commercial |
$789.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.66
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$806.58
|
| Rate for Payer: Health EOS Commercial |
$780.28
|
| Rate for Payer: HFN Commercial |
$806.58
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: Preferred Network Access Commercial |
$806.58
|
| Rate for Payer: Quartz Beloit One Network |
$429.59
|
| Rate for Payer: Quartz Commercial |
$526.03
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$649.36
|
|
