|
REAMER TWO-STEP CONCAVE 8MM 220-08-001
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
4452943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
REAMER TWO-STEP CONVEX 10MM 220-10-002
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3693503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$12,664.00 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Aetna Managed Medicare |
$886.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,771.69
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,374.50
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$2,057.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,899.60
|
| Rate for Payer: The Alliance Commercial |
$12,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
REAMER TWO-STEP CONVEX 10MM 220-10-002
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3693503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
REAMER TWO-STEP CONVEX 12MM 220-12-002
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
4858691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
REAMER TWO-STEP CONVEX 12MM 220-12-002
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
4858691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Aetna Managed Medicare |
$744.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.54
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.00
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,729.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.00
|
| Rate for Payer: The Alliance Commercial |
$10,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
REAMER TWO-STEP CONVEX 8MM 220-08-002
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
4452944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$12,664.00 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Aetna Managed Medicare |
$886.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,771.69
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,374.50
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$2,057.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,899.60
|
| Rate for Payer: The Alliance Commercial |
$12,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
REAMER TWO-STEP CONVEX 8MM 220-08-002
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
4452944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
REAMER UNIVERS VAULTLOCK AUGMENTED GLENOID ANGLED LARGE AR-9275-L
|
Facility
|
OP
|
$2,902.00
|
|
| Hospital Charge Code |
6151659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
REAMER UNIVERS VAULTLOCK AUGMENTED GLENOID ANGLED LARGE AR-9275-L
|
Facility
|
IP
|
$2,902.00
|
|
| Hospital Charge Code |
6151659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED MEDIUM AR-9275-M
|
Facility
|
IP
|
$3,018.00
|
|
| Hospital Charge Code |
5895635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.82 |
| Max. Negotiated Rate |
$2,776.56 |
| Rate for Payer: Aetna Commercial |
$2,716.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.54
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,776.56
|
| Rate for Payer: Health EOS Commercial |
$2,686.02
|
| Rate for Payer: HFN Commercial |
$2,776.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.82
|
| Rate for Payer: Quartz Commercial |
$1,810.80
|
| Rate for Payer: WEA Trust Commercial |
$1,659.90
|
| Rate for Payer: WPS Commercial |
$2,235.43
|
|
|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED MEDIUM AR-9275-M
|
Facility
|
OP
|
$3,018.00
|
|
| Hospital Charge Code |
5895635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.04 |
| Max. Negotiated Rate |
$12,072.00 |
| Rate for Payer: Aetna Commercial |
$2,716.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.48
|
| Rate for Payer: Aetna Managed Medicare |
$845.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.54
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,776.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.87
|
| Rate for Payer: Health EOS Commercial |
$2,686.02
|
| Rate for Payer: HFN Commercial |
$2,776.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.50
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.82
|
| Rate for Payer: Quartz Commercial |
$1,961.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.80
|
| Rate for Payer: The Alliance Commercial |
$12,072.00
|
| Rate for Payer: WEA Trust Commercial |
$1,659.90
|
| Rate for Payer: WPS Commercial |
$2,235.43
|
|
|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED SMALL AR-9275-S
|
Facility
|
OP
|
$2,790.00
|
|
| Hospital Charge Code |
6178082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
REAMER UNIVERS VAULTOCK AUGMENTED GLENOID ANGLED SMALL AR-9275-S
|
Facility
|
IP
|
$2,790.00
|
|
| Hospital Charge Code |
6178082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
REAMER VIP GLENOID AUGMENTED MGS SMALL AR-5410-AMGS-S
|
Facility
|
OP
|
$4,256.00
|
|
| Hospital Charge Code |
6204973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.68 |
| Max. Negotiated Rate |
$17,024.00 |
| Rate for Payer: Aetna Commercial |
$3,830.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,660.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,766.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,042.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,255.68
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$3,915.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,381.66
|
| Rate for Payer: Health EOS Commercial |
$3,787.84
|
| Rate for Payer: HFN Commercial |
$3,915.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,192.00
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,553.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,915.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.44
|
| Rate for Payer: Quartz Commercial |
$2,766.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,553.60
|
| Rate for Payer: The Alliance Commercial |
$17,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
REAMER VIP GLENOID AUGMENTED MGS SMALL AR-5410-AMGS-S
|
Facility
|
IP
|
$4,256.00
|
|
| Hospital Charge Code |
6204973
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,085.44 |
| Max. Negotiated Rate |
$3,915.52 |
| Rate for Payer: Aetna Commercial |
$3,830.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,660.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,255.68
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$3,915.52
|
| Rate for Payer: Health EOS Commercial |
$3,787.84
|
| Rate for Payer: HFN Commercial |
$3,915.52
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,553.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,915.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.44
|
| Rate for Payer: Quartz Commercial |
$2,553.60
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
REAMING ROD W BALL TIP 2.5MM 650MM 351.709S
|
Facility
|
IP
|
$1,880.00
|
|
| Hospital Charge Code |
2966384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$921.20 |
| Max. Negotiated Rate |
$1,729.60 |
| Rate for Payer: Aetna Commercial |
$1,692.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,616.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$996.40
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$1,729.60
|
| Rate for Payer: Health EOS Commercial |
$1,673.20
|
| Rate for Payer: HFN Commercial |
$1,729.60
|
| Rate for Payer: Multiplan Commercial |
$1,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,729.60
|
| Rate for Payer: Quartz Beloit One Network |
$921.20
|
| Rate for Payer: Quartz Commercial |
$1,128.00
|
| Rate for Payer: WEA Trust Commercial |
$1,034.00
|
| Rate for Payer: WPS Commercial |
$1,392.52
|
|
|
REAMING ROD W BALL TIP 2.5MM 650MM 351.709S
|
Facility
|
OP
|
$1,880.00
|
|
| Hospital Charge Code |
2966384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$7,520.00 |
| Rate for Payer: Aetna Commercial |
$1,692.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,616.80
|
| Rate for Payer: Aetna Managed Medicare |
$526.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,222.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$940.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$902.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$996.40
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$1,729.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,052.05
|
| Rate for Payer: Health EOS Commercial |
$1,673.20
|
| Rate for Payer: HFN Commercial |
$1,729.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$1,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,729.60
|
| Rate for Payer: Quartz Beloit One Network |
$921.20
|
| Rate for Payer: Quartz Commercial |
$1,222.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,128.00
|
| Rate for Payer: The Alliance Commercial |
$7,520.00
|
| Rate for Payer: WEA Trust Commercial |
$1,034.00
|
| Rate for Payer: WPS Commercial |
$1,392.52
|
|
|
Reclast 5 mg Charge
|
Facility
|
IP
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,923.34 |
| Max. Negotiated Rate |
$5,488.72 |
| Rate for Payer: Aetna Commercial |
$5,369.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.98
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,488.72
|
| Rate for Payer: Health EOS Commercial |
$5,309.74
|
| Rate for Payer: HFN Commercial |
$5,488.72
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,488.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.34
|
| Rate for Payer: Quartz Commercial |
$3,579.60
|
| Rate for Payer: WEA Trust Commercial |
$3,281.30
|
| Rate for Payer: WPS Commercial |
$4,419.02
|
|
|
Reclast 5 mg Charge
|
Professional
|
Both
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$5,667.70 |
| Rate for Payer: Aetna Commercial |
$5,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.76
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,667.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.94
|
| Rate for Payer: Health EOS Commercial |
$5,429.06
|
| Rate for Payer: HFN Commercial |
$5,667.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.04
|
| Rate for Payer: Quartz Commercial |
$3,400.62
|
| Rate for Payer: The Alliance Commercial |
$2,983.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.94
|
| Rate for Payer: WEA Trust Commercial |
$3,281.30
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
Reclast 5 mg Charge
|
Facility
|
OP
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$23,864.00 |
| Rate for Payer: Aetna Commercial |
$5,369.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,877.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,983.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.98
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,488.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.18
|
| Rate for Payer: Health EOS Commercial |
$5,309.74
|
| Rate for Payer: HFN Commercial |
$5,488.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,474.50
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,488.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.34
|
| Rate for Payer: Quartz Commercial |
$3,877.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.60
|
| Rate for Payer: The Alliance Commercial |
$23,864.00
|
| Rate for Payer: WEA Trust Commercial |
$3,281.30
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
Reclast 5mg charge J3489
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,980.67 |
| Max. Negotiated Rate |
$5,596.36 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,649.80
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
Reclast 5mg charge J3489
|
Professional
|
Both
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$5,778.85 |
| Rate for Payer: Aetna Commercial |
$5,778.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,778.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.94
|
| Rate for Payer: Health EOS Commercial |
$5,535.53
|
| Rate for Payer: HFN Commercial |
$5,778.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,778.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,676.52
|
| Rate for Payer: Quartz Commercial |
$3,467.31
|
| Rate for Payer: The Alliance Commercial |
$3,041.50
|
| Rate for Payer: United Healthcare Medicaid |
$6.94
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
Reclast 5mg charge J3489
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$24,332.00 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,703.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,041.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.18
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,562.25
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,953.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.80
|
| Rate for Payer: The Alliance Commercial |
$24,332.00
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
RECON SCREW 6.5MM/100MM X L40MM FOR IM NAIL 04.046.700S
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.80 |
| Max. Negotiated Rate |
$2,134.40 |
| Rate for Payer: Aetna Commercial |
$2,088.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,995.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,229.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,134.40
|
| Rate for Payer: Health EOS Commercial |
$2,064.80
|
| Rate for Payer: HFN Commercial |
$2,134.40
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,134.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.80
|
| Rate for Payer: Quartz Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.00
|
| Rate for Payer: WPS Commercial |
$1,718.42
|
|
|
RECON SCREW 6.5MM/100MM X L40MM FOR IM NAIL 04.046.700S
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.60 |
| Max. Negotiated Rate |
$9,280.00 |
| Rate for Payer: Aetna Commercial |
$2,088.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,995.20
|
| Rate for Payer: Aetna Managed Medicare |
$649.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,113.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,229.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,134.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,298.27
|
| Rate for Payer: Health EOS Commercial |
$2,064.80
|
| Rate for Payer: HFN Commercial |
$2,134.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.00
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,134.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.80
|
| Rate for Payer: Quartz Commercial |
$1,508.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.00
|
| Rate for Payer: The Alliance Commercial |
$9,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.00
|
| Rate for Payer: WPS Commercial |
$1,718.42
|
|
