|
REAMER CUP 20MM XFR004120
|
Facility
|
IP
|
$6,250.00
|
|
| Hospital Charge Code |
5591288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,185.00 |
| Max. Negotiated Rate |
$5,980.00 |
| Rate for Payer: Aetna Commercial |
$5,850.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,590.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,445.00
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cigna Commercial |
$5,980.00
|
| Rate for Payer: Health EOS Commercial |
$5,785.00
|
| Rate for Payer: HFN Commercial |
$5,980.00
|
| Rate for Payer: Multiplan Commercial |
$5,200.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.00
|
| Rate for Payer: Quartz Commercial |
$3,900.00
|
| Rate for Payer: WEA Trust Commercial |
$3,575.00
|
| Rate for Payer: WPS Commercial |
$4,814.38
|
|
|
REAMER CUP 22MM XFR004122
|
Facility
|
IP
|
$5,087.00
|
|
| Hospital Charge Code |
5831732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,592.34 |
| Max. Negotiated Rate |
$4,867.24 |
| Rate for Payer: Aetna Commercial |
$4,761.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,549.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,803.95
|
| Rate for Payer: Cash Price |
$1,526.10
|
| Rate for Payer: Cigna Commercial |
$4,867.24
|
| Rate for Payer: Health EOS Commercial |
$4,708.53
|
| Rate for Payer: HFN Commercial |
$4,867.24
|
| Rate for Payer: Multiplan Commercial |
$4,232.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,867.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,592.34
|
| Rate for Payer: Quartz Commercial |
$3,174.29
|
| Rate for Payer: WEA Trust Commercial |
$2,909.76
|
| Rate for Payer: WPS Commercial |
$3,918.52
|
|
|
REAMER CUP 22MM XFR004122
|
Facility
|
OP
|
$5,087.00
|
|
| Hospital Charge Code |
5831732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,481.33 |
| Max. Negotiated Rate |
$4,867.24 |
| Rate for Payer: Aetna Commercial |
$4,761.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,549.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,481.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,438.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,645.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,539.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,803.95
|
| Rate for Payer: Cash Price |
$1,526.10
|
| Rate for Payer: Cigna Commercial |
$4,867.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,960.63
|
| Rate for Payer: Health EOS Commercial |
$4,708.53
|
| Rate for Payer: HFN Commercial |
$4,867.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,967.86
|
| Rate for Payer: Multiplan Commercial |
$4,232.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,174.29
|
| Rate for Payer: Preferred Network Access Commercial |
$4,867.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,592.34
|
| Rate for Payer: Quartz Commercial |
$3,438.81
|
| Rate for Payer: Quartz Medicare Advantage |
$3,174.29
|
| Rate for Payer: The Alliance Commercial |
$2,645.24
|
| Rate for Payer: WEA Trust Commercial |
$2,909.76
|
| Rate for Payer: WPS Commercial |
$3,918.52
|
|
|
REAMER CUP MTP 16MM GEN 2 455 SS 58890116
|
Facility
|
OP
|
$2,111.00
|
|
| Hospital Charge Code |
6206990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.72 |
| Max. Negotiated Rate |
$2,019.80 |
| Rate for Payer: Aetna Commercial |
$1,975.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.08
|
| Rate for Payer: Aetna Managed Medicare |
$614.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.58
|
| Rate for Payer: Cash Price |
$633.30
|
| Rate for Payer: Cigna Commercial |
$2,019.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.60
|
| Rate for Payer: Health EOS Commercial |
$1,953.94
|
| Rate for Payer: HFN Commercial |
$2,019.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,646.58
|
| Rate for Payer: Multiplan Commercial |
$1,756.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.77
|
| Rate for Payer: Quartz Commercial |
$1,427.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.26
|
| Rate for Payer: The Alliance Commercial |
$1,097.72
|
| Rate for Payer: WEA Trust Commercial |
$1,207.49
|
| Rate for Payer: WPS Commercial |
$1,626.10
|
|
|
REAMER CUP MTP 16MM GEN 2 455 SS 58890116
|
Facility
|
IP
|
$2,111.00
|
|
| Hospital Charge Code |
6206990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.77 |
| Max. Negotiated Rate |
$2,019.80 |
| Rate for Payer: Aetna Commercial |
$1,975.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.58
|
| Rate for Payer: Cash Price |
$633.30
|
| Rate for Payer: Cigna Commercial |
$2,019.80
|
| Rate for Payer: Health EOS Commercial |
$1,953.94
|
| Rate for Payer: HFN Commercial |
$2,019.80
|
| Rate for Payer: Multiplan Commercial |
$1,756.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.77
|
| Rate for Payer: Quartz Commercial |
$1,317.26
|
| Rate for Payer: WEA Trust Commercial |
$1,207.49
|
| Rate for Payer: WPS Commercial |
$1,626.10
|
|
|
REAMER CUP MTP 18MM GEN 2 455 SS 58890118
|
Facility
|
IP
|
$3,046.00
|
|
| Hospital Charge Code |
6049633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,552.24 |
| Max. Negotiated Rate |
$2,914.41 |
| Rate for Payer: Aetna Commercial |
$2,851.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,724.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,678.96
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$2,914.41
|
| Rate for Payer: Health EOS Commercial |
$2,819.38
|
| Rate for Payer: HFN Commercial |
$2,914.41
|
| Rate for Payer: Multiplan Commercial |
$2,534.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,914.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,552.24
|
| Rate for Payer: Quartz Commercial |
$1,900.70
|
| Rate for Payer: WEA Trust Commercial |
$1,742.31
|
| Rate for Payer: WPS Commercial |
$2,346.33
|
|
|
REAMER CUP MTP 18MM GEN 2 455 SS 58890118
|
Facility
|
OP
|
$3,046.00
|
|
| Hospital Charge Code |
6049633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.00 |
| Max. Negotiated Rate |
$2,914.41 |
| Rate for Payer: Aetna Commercial |
$2,851.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,724.34
|
| Rate for Payer: Aetna Managed Medicare |
$887.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,059.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,520.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,678.96
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$2,914.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,772.77
|
| Rate for Payer: Health EOS Commercial |
$2,819.38
|
| Rate for Payer: HFN Commercial |
$2,914.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,375.88
|
| Rate for Payer: Multiplan Commercial |
$2,534.27
|
| Rate for Payer: NAPHCARE Commercial |
$1,900.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,914.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,552.24
|
| Rate for Payer: Quartz Commercial |
$2,059.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,900.70
|
| Rate for Payer: The Alliance Commercial |
$1,583.92
|
| Rate for Payer: WEA Trust Commercial |
$1,742.31
|
| Rate for Payer: WPS Commercial |
$2,346.33
|
|
|
REAMER CUP MTP 20MM 58890120
|
Facility
|
IP
|
$3,322.00
|
|
| Hospital Charge Code |
5895657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,692.89 |
| Max. Negotiated Rate |
$3,178.49 |
| Rate for Payer: Aetna Commercial |
$3,109.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,971.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.09
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$3,178.49
|
| Rate for Payer: Health EOS Commercial |
$3,074.84
|
| Rate for Payer: HFN Commercial |
$3,178.49
|
| Rate for Payer: Multiplan Commercial |
$2,763.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,178.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,692.89
|
| Rate for Payer: Quartz Commercial |
$2,072.93
|
| Rate for Payer: WEA Trust Commercial |
$1,900.18
|
| Rate for Payer: WPS Commercial |
$2,558.94
|
|
|
REAMER CUP MTP 20MM 58890120
|
Facility
|
OP
|
$3,322.00
|
|
| Hospital Charge Code |
5895657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$967.37 |
| Max. Negotiated Rate |
$3,178.49 |
| Rate for Payer: Aetna Commercial |
$3,109.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,971.20
|
| Rate for Payer: Aetna Managed Medicare |
$967.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,245.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,727.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.09
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$3,178.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,933.40
|
| Rate for Payer: Health EOS Commercial |
$3,074.84
|
| Rate for Payer: HFN Commercial |
$3,178.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,591.16
|
| Rate for Payer: Multiplan Commercial |
$2,763.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,072.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,178.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,692.89
|
| Rate for Payer: Quartz Commercial |
$2,245.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,072.93
|
| Rate for Payer: The Alliance Commercial |
$1,727.44
|
| Rate for Payer: WEA Trust Commercial |
$1,900.18
|
| Rate for Payer: WPS Commercial |
$2,558.94
|
|
|
REAMER CUP MTP 22MM 58890122
|
Facility
|
IP
|
$2,204.00
|
|
| Hospital Charge Code |
6216985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,123.16 |
| Max. Negotiated Rate |
$2,108.79 |
| Rate for Payer: Aetna Commercial |
$2,062.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.84
|
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cigna Commercial |
$2,108.79
|
| Rate for Payer: Health EOS Commercial |
$2,040.02
|
| Rate for Payer: HFN Commercial |
$2,108.79
|
| Rate for Payer: Multiplan Commercial |
$1,833.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,108.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.16
|
| Rate for Payer: Quartz Commercial |
$1,375.30
|
| Rate for Payer: WEA Trust Commercial |
$1,260.69
|
| Rate for Payer: WPS Commercial |
$1,697.74
|
|
|
REAMER CUP MTP 22MM 58890122
|
Facility
|
OP
|
$2,204.00
|
|
| Hospital Charge Code |
6216985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.80 |
| Max. Negotiated Rate |
$2,108.79 |
| Rate for Payer: Aetna Commercial |
$2,062.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.26
|
| Rate for Payer: Aetna Managed Medicare |
$641.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.84
|
| Rate for Payer: Cash Price |
$661.20
|
| Rate for Payer: Cigna Commercial |
$2,108.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,282.73
|
| Rate for Payer: Health EOS Commercial |
$2,040.02
|
| Rate for Payer: HFN Commercial |
$2,108.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,719.12
|
| Rate for Payer: Multiplan Commercial |
$1,833.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,108.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.16
|
| Rate for Payer: Quartz Commercial |
$1,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,375.30
|
| Rate for Payer: The Alliance Commercial |
$1,146.08
|
| Rate for Payer: WEA Trust Commercial |
$1,260.69
|
| Rate for Payer: WPS Commercial |
$1,697.74
|
|
|
REAMER FOR CROSS-PLATE 705172
|
Facility
|
OP
|
$3,655.00
|
|
| Hospital Charge Code |
5547412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,064.34 |
| Max. Negotiated Rate |
$3,497.10 |
| Rate for Payer: Aetna Commercial |
$3,421.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,470.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,900.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,824.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,014.64
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$3,497.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,127.21
|
| Rate for Payer: Health EOS Commercial |
$3,383.07
|
| Rate for Payer: HFN Commercial |
$3,497.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,850.90
|
| Rate for Payer: Multiplan Commercial |
$3,040.96
|
| Rate for Payer: NAPHCARE Commercial |
$2,280.72
|
| Rate for Payer: Preferred Network Access Commercial |
$3,497.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,862.59
|
| Rate for Payer: Quartz Commercial |
$2,470.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,280.72
|
| Rate for Payer: The Alliance Commercial |
$1,900.60
|
| Rate for Payer: WEA Trust Commercial |
$2,090.66
|
| Rate for Payer: WPS Commercial |
$2,815.45
|
|
|
REAMER FOR CROSS-PLATE 705172
|
Facility
|
IP
|
$3,655.00
|
|
| Hospital Charge Code |
5547412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,862.59 |
| Max. Negotiated Rate |
$3,497.10 |
| Rate for Payer: Aetna Commercial |
$3,421.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,014.64
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$3,497.10
|
| Rate for Payer: Health EOS Commercial |
$3,383.07
|
| Rate for Payer: HFN Commercial |
$3,497.10
|
| Rate for Payer: Multiplan Commercial |
$3,040.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,497.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,862.59
|
| Rate for Payer: Quartz Commercial |
$2,280.72
|
| Rate for Payer: WEA Trust Commercial |
$2,090.66
|
| Rate for Payer: WPS Commercial |
$2,815.45
|
|
|
REAMER HEAD ANGLED S AR-9675-S
|
Facility
|
OP
|
$3,018.00
|
|
| Hospital Charge Code |
5659648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.84 |
| Max. Negotiated Rate |
$2,887.62 |
| Rate for Payer: Aetna Commercial |
$2,824.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.30
|
| Rate for Payer: Aetna Managed Medicare |
$878.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.52
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,887.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.48
|
| Rate for Payer: Health EOS Commercial |
$2,793.46
|
| Rate for Payer: HFN Commercial |
$2,887.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.04
|
| Rate for Payer: Multiplan Commercial |
$2,510.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.97
|
| Rate for Payer: Quartz Commercial |
$2,040.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.23
|
| Rate for Payer: The Alliance Commercial |
$1,569.36
|
| Rate for Payer: WEA Trust Commercial |
$1,726.30
|
| Rate for Payer: WPS Commercial |
$2,324.77
|
|
|
REAMER HEAD ANGLED S AR-9675-S
|
Facility
|
IP
|
$3,018.00
|
|
| Hospital Charge Code |
5659648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$2,887.62 |
| Rate for Payer: Aetna Commercial |
$2,824.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.52
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,887.62
|
| Rate for Payer: Health EOS Commercial |
$2,793.46
|
| Rate for Payer: HFN Commercial |
$2,887.62
|
| Rate for Payer: Multiplan Commercial |
$2,510.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.97
|
| Rate for Payer: Quartz Commercial |
$1,883.23
|
| Rate for Payer: WEA Trust Commercial |
$1,726.30
|
| Rate for Payer: WPS Commercial |
$2,324.77
|
|
|
REAMER HEAD RIA 2 10.5MM STERILE 03.404.017S
|
Facility
|
OP
|
$4,835.00
|
|
| Hospital Charge Code |
6001636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,407.95 |
| Max. Negotiated Rate |
$4,626.13 |
| Rate for Payer: Aetna Commercial |
$4,525.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,407.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,268.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,413.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.05
|
| Rate for Payer: Cash Price |
$1,450.50
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,813.97
|
| Rate for Payer: Health EOS Commercial |
$4,475.28
|
| Rate for Payer: HFN Commercial |
$4,626.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,771.30
|
| Rate for Payer: Multiplan Commercial |
$4,022.72
|
| Rate for Payer: NAPHCARE Commercial |
$3,017.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.92
|
| Rate for Payer: Quartz Commercial |
$3,268.46
|
| Rate for Payer: Quartz Medicare Advantage |
$3,017.04
|
| Rate for Payer: The Alliance Commercial |
$2,514.20
|
| Rate for Payer: WEA Trust Commercial |
$2,765.62
|
| Rate for Payer: WPS Commercial |
$3,724.40
|
|
|
REAMER HEAD RIA 2 10.5MM STERILE 03.404.017S
|
Facility
|
IP
|
$4,835.00
|
|
| Hospital Charge Code |
6001636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,463.92 |
| Max. Negotiated Rate |
$4,626.13 |
| Rate for Payer: Aetna Commercial |
$4,525.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.05
|
| Rate for Payer: Cash Price |
$1,450.50
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: Health EOS Commercial |
$4,475.28
|
| Rate for Payer: HFN Commercial |
$4,626.13
|
| Rate for Payer: Multiplan Commercial |
$4,022.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.92
|
| Rate for Payer: Quartz Commercial |
$3,017.04
|
| Rate for Payer: WEA Trust Commercial |
$2,765.62
|
| Rate for Payer: WPS Commercial |
$3,724.40
|
|
|
REAMER HEAD RIA 2 11.0MM STERILE 03.404.018S
|
Facility
|
IP
|
$4,835.00
|
|
| Hospital Charge Code |
6001635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,463.92 |
| Max. Negotiated Rate |
$4,626.13 |
| Rate for Payer: Aetna Commercial |
$4,525.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.05
|
| Rate for Payer: Cash Price |
$1,450.50
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: Health EOS Commercial |
$4,475.28
|
| Rate for Payer: HFN Commercial |
$4,626.13
|
| Rate for Payer: Multiplan Commercial |
$4,022.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.92
|
| Rate for Payer: Quartz Commercial |
$3,017.04
|
| Rate for Payer: WEA Trust Commercial |
$2,765.62
|
| Rate for Payer: WPS Commercial |
$3,724.40
|
|
|
REAMER HEAD RIA 2 11.0MM STERILE 03.404.018S
|
Facility
|
OP
|
$4,835.00
|
|
| Hospital Charge Code |
6001635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,407.95 |
| Max. Negotiated Rate |
$4,626.13 |
| Rate for Payer: Aetna Commercial |
$4,525.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,407.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,268.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,413.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.05
|
| Rate for Payer: Cash Price |
$1,450.50
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,813.97
|
| Rate for Payer: Health EOS Commercial |
$4,475.28
|
| Rate for Payer: HFN Commercial |
$4,626.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,771.30
|
| Rate for Payer: Multiplan Commercial |
$4,022.72
|
| Rate for Payer: NAPHCARE Commercial |
$3,017.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.92
|
| Rate for Payer: Quartz Commercial |
$3,268.46
|
| Rate for Payer: Quartz Medicare Advantage |
$3,017.04
|
| Rate for Payer: The Alliance Commercial |
$2,514.20
|
| Rate for Payer: WEA Trust Commercial |
$2,765.62
|
| Rate for Payer: WPS Commercial |
$3,724.40
|
|
|
REAMER METATARSAL 18MM AR-8944MR-18
|
Facility
|
IP
|
$4,787.00
|
|
| Hospital Charge Code |
5459678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,439.46 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$2,987.09
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
REAMER METATARSAL 18MM AR-8944MR-18
|
Facility
|
OP
|
$4,787.00
|
|
| Hospital Charge Code |
5459678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,393.97 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,236.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,786.03
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.86
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,987.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$3,236.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,987.09
|
| Rate for Payer: The Alliance Commercial |
$2,489.24
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
REAMER METATARSAL 22MM AR-8944MR-22
|
Facility
|
OP
|
$4,787.00
|
|
| Hospital Charge Code |
5603771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,393.97 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,236.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,786.03
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.86
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,987.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$3,236.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,987.09
|
| Rate for Payer: The Alliance Commercial |
$2,489.24
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
REAMER METATARSAL 22MM AR-8944MR-22
|
Facility
|
IP
|
$4,787.00
|
|
| Hospital Charge Code |
5603771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,439.46 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$2,987.09
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
REAMER OPENING DRILL ASSEMBLY 12.5MM 03.168.006
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
6178985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,915.42 |
| Max. Negotiated Rate |
$5,473.85 |
| Rate for Payer: Aetna Commercial |
$5,354.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,116.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.42
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,473.85
|
| Rate for Payer: Health EOS Commercial |
$5,295.36
|
| Rate for Payer: HFN Commercial |
$5,473.85
|
| Rate for Payer: Multiplan Commercial |
$4,759.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,473.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.42
|
| Rate for Payer: Quartz Commercial |
$3,569.90
|
| Rate for Payer: WEA Trust Commercial |
$3,272.41
|
| Rate for Payer: WPS Commercial |
$4,406.89
|
|
|
REAMER OPENING DRILL ASSEMBLY 12.5MM 03.168.006
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
6178985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,665.96 |
| Max. Negotiated Rate |
$5,473.85 |
| Rate for Payer: Aetna Commercial |
$5,354.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,116.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,665.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,867.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,974.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,855.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.42
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,473.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,329.62
|
| Rate for Payer: Health EOS Commercial |
$5,295.36
|
| Rate for Payer: HFN Commercial |
$5,473.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,462.38
|
| Rate for Payer: Multiplan Commercial |
$4,759.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,569.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,473.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.42
|
| Rate for Payer: Quartz Commercial |
$3,867.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,569.90
|
| Rate for Payer: The Alliance Commercial |
$2,974.92
|
| Rate for Payer: WEA Trust Commercial |
$3,272.41
|
| Rate for Payer: WPS Commercial |
$4,406.89
|
|
