|
RBC Washed
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$721.28 |
| Max. Negotiated Rate |
$1,354.24 |
| Rate for Payer: Aetna Commercial |
$1,324.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,265.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.16
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,354.24
|
| Rate for Payer: Health EOS Commercial |
$1,310.08
|
| Rate for Payer: HFN Commercial |
$1,354.24
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$883.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.24
|
| Rate for Payer: Quartz Beloit One Network |
$721.28
|
| Rate for Payer: Quartz Commercial |
$883.20
|
| Rate for Payer: WEA Trust Commercial |
$809.60
|
| Rate for Payer: WPS Commercial |
$1,090.31
|
|
|
REACHER 26 6 OZ. #4109"
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2970515
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
REACHER 26 6 OZ. #4109"
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2970515
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
REACHER 26 STANDARD #A665-17
|
Facility
|
IP
|
$274.00
|
|
| Hospital Charge Code |
2970862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
REACHER 26 STANDARD #A665-17
|
Facility
|
OP
|
$274.00
|
|
| Hospital Charge Code |
2970862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$76.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.33
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$164.40
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
READYWRAP QUICK-FIT FOOT #RQ-LE-AB-M23
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
2971698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$418.95 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Aetna Commercial |
$769.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.15
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$786.60
|
| Rate for Payer: Health EOS Commercial |
$760.95
|
| Rate for Payer: HFN Commercial |
$786.60
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: NAPHCARE Commercial |
$513.00
|
| Rate for Payer: Preferred Network Access Commercial |
$786.60
|
| Rate for Payer: Quartz Beloit One Network |
$418.95
|
| Rate for Payer: Quartz Commercial |
$513.00
|
| Rate for Payer: WEA Trust Commercial |
$470.25
|
| Rate for Payer: WPS Commercial |
$633.30
|
|
|
READYWRAP QUICK-FIT FOOT #RQ-LE-AB-M23
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
2971698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$3,420.00 |
| Rate for Payer: Aetna Commercial |
$769.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.30
|
| Rate for Payer: Aetna Managed Medicare |
$239.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.15
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$786.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.46
|
| Rate for Payer: Health EOS Commercial |
$760.95
|
| Rate for Payer: HFN Commercial |
$786.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.25
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: NAPHCARE Commercial |
$513.00
|
| Rate for Payer: Preferred Network Access Commercial |
$786.60
|
| Rate for Payer: Quartz Beloit One Network |
$418.95
|
| Rate for Payer: Quartz Commercial |
$555.75
|
| Rate for Payer: Quartz Medicare Advantage |
$513.00
|
| Rate for Payer: The Alliance Commercial |
$3,420.00
|
| Rate for Payer: WEA Trust Commercial |
$470.25
|
| Rate for Payer: WPS Commercial |
$633.30
|
|
|
REAMER 10.0MM CORING CR8850
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
2964943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.84 |
| Max. Negotiated Rate |
$10,312.00 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Aetna Managed Medicare |
$721.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.65
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,933.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,675.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.80
|
| Rate for Payer: The Alliance Commercial |
$10,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
REAMER 10.0MM CORING CR8850
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
2964943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.22 |
| Max. Negotiated Rate |
$2,371.76 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,546.80
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
REAMER 10MM LOW PROFILE AR-1410LP
|
Facility
|
IP
|
$3,404.00
|
|
| Hospital Charge Code |
2964693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,667.96 |
| Max. Negotiated Rate |
$3,131.68 |
| Rate for Payer: Aetna Commercial |
$3,063.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,927.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,804.12
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,131.68
|
| Rate for Payer: Health EOS Commercial |
$3,029.56
|
| Rate for Payer: HFN Commercial |
$3,131.68
|
| Rate for Payer: Multiplan Commercial |
$2,723.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,042.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,131.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,667.96
|
| Rate for Payer: Quartz Commercial |
$2,042.40
|
| Rate for Payer: WEA Trust Commercial |
$1,872.20
|
| Rate for Payer: WPS Commercial |
$2,521.34
|
|
|
REAMER 10MM LOW PROFILE AR-1410LP
|
Facility
|
OP
|
$3,404.00
|
|
| Hospital Charge Code |
2964693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$953.12 |
| Max. Negotiated Rate |
$13,616.00 |
| Rate for Payer: Aetna Commercial |
$3,063.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,927.44
|
| Rate for Payer: Aetna Managed Medicare |
$953.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,212.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,702.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,633.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,804.12
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,131.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,904.88
|
| Rate for Payer: Health EOS Commercial |
$3,029.56
|
| Rate for Payer: HFN Commercial |
$3,131.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,553.00
|
| Rate for Payer: Multiplan Commercial |
$2,723.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,042.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,131.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,667.96
|
| Rate for Payer: Quartz Commercial |
$2,212.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,042.40
|
| Rate for Payer: The Alliance Commercial |
$13,616.00
|
| Rate for Payer: WEA Trust Commercial |
$1,872.20
|
| Rate for Payer: WPS Commercial |
$2,521.34
|
|
|
REAMER 11.OMM CORING CR8851
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
2964944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.84 |
| Max. Negotiated Rate |
$10,312.00 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Aetna Managed Medicare |
$721.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.65
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,933.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,675.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.80
|
| Rate for Payer: The Alliance Commercial |
$10,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
REAMER 11.OMM CORING CR8851
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
2964944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.22 |
| Max. Negotiated Rate |
$2,371.76 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,546.80
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
REAMER 2.0 SMART TOE
|
Facility
|
OP
|
$3,149.00
|
|
| Hospital Charge Code |
2966088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.72 |
| Max. Negotiated Rate |
$12,596.00 |
| Rate for Payer: Aetna Commercial |
$2,834.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,708.14
|
| Rate for Payer: Aetna Managed Medicare |
$881.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,046.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,574.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,511.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,668.97
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$2,897.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,762.18
|
| Rate for Payer: Health EOS Commercial |
$2,802.61
|
| Rate for Payer: HFN Commercial |
$2,897.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,361.75
|
| Rate for Payer: Multiplan Commercial |
$2,519.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,543.01
|
| Rate for Payer: Quartz Commercial |
$2,046.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,889.40
|
| Rate for Payer: The Alliance Commercial |
$12,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,731.95
|
| Rate for Payer: WPS Commercial |
$2,332.46
|
|
|
REAMER 2.0 SMART TOE
|
Facility
|
IP
|
$3,149.00
|
|
| Hospital Charge Code |
2966088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,543.01 |
| Max. Negotiated Rate |
$2,897.08 |
| Rate for Payer: Aetna Commercial |
$2,834.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,708.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,668.97
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$2,897.08
|
| Rate for Payer: Health EOS Commercial |
$2,802.61
|
| Rate for Payer: HFN Commercial |
$2,897.08
|
| Rate for Payer: Multiplan Commercial |
$2,519.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,543.01
|
| Rate for Payer: Quartz Commercial |
$1,889.40
|
| Rate for Payer: WEA Trust Commercial |
$1,731.95
|
| Rate for Payer: WPS Commercial |
$2,332.46
|
|
|
REAMER 8.5MM PILOTED HEADED AR-1455
|
Facility
|
IP
|
$3,710.00
|
|
| Hospital Charge Code |
3661497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,817.90 |
| Max. Negotiated Rate |
$3,413.20 |
| Rate for Payer: Aetna Commercial |
$3,339.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,190.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,966.30
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$3,413.20
|
| Rate for Payer: Health EOS Commercial |
$3,301.90
|
| Rate for Payer: HFN Commercial |
$3,413.20
|
| Rate for Payer: Multiplan Commercial |
$2,968.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,226.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,413.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,817.90
|
| Rate for Payer: Quartz Commercial |
$2,226.00
|
| Rate for Payer: WEA Trust Commercial |
$2,040.50
|
| Rate for Payer: WPS Commercial |
$2,748.00
|
|
|
REAMER 8.5MM PILOTED HEADED AR-1455
|
Facility
|
OP
|
$3,710.00
|
|
| Hospital Charge Code |
3661497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,038.80 |
| Max. Negotiated Rate |
$14,840.00 |
| Rate for Payer: Aetna Commercial |
$3,339.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,190.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,038.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,411.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,855.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,780.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,966.30
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cigna Commercial |
$3,413.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,076.12
|
| Rate for Payer: Health EOS Commercial |
$3,301.90
|
| Rate for Payer: HFN Commercial |
$3,413.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,782.50
|
| Rate for Payer: Multiplan Commercial |
$2,968.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,226.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,413.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,817.90
|
| Rate for Payer: Quartz Commercial |
$2,411.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,226.00
|
| Rate for Payer: The Alliance Commercial |
$14,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,040.50
|
| Rate for Payer: WPS Commercial |
$2,748.00
|
|
|
REAMER 9.0MM CORING CR8849
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
2969481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.22 |
| Max. Negotiated Rate |
$2,371.76 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,546.80
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
REAMER 9.0MM CORING CR8849
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
2969481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.84 |
| Max. Negotiated Rate |
$10,312.00 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Aetna Managed Medicare |
$721.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.65
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,933.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,675.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.80
|
| Rate for Payer: The Alliance Commercial |
$10,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
REAMER CIRCULAR MTP 18MM AR-8944MC-18
|
Facility
|
OP
|
$4,787.00
|
|
| Hospital Charge Code |
5459677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,340.36 |
| Max. Negotiated Rate |
$19,148.00 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.81
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.25
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$3,111.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.20
|
| Rate for Payer: The Alliance Commercial |
$19,148.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
REAMER CIRCULAR MTP 18MM AR-8944MC-18
|
Facility
|
IP
|
$4,787.00
|
|
| Hospital Charge Code |
5459677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,345.63 |
| Max. Negotiated Rate |
$4,404.04 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$2,872.20
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
REAMER CONCAVE 16MM XFR004116
|
Facility
|
IP
|
$5,087.00
|
|
| Hospital Charge Code |
5804044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,492.63 |
| Max. Negotiated Rate |
$4,680.04 |
| Rate for Payer: Aetna Commercial |
$4,578.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,374.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,696.11
|
| Rate for Payer: Cash Price |
$1,526.10
|
| Rate for Payer: Cigna Commercial |
$4,680.04
|
| Rate for Payer: Health EOS Commercial |
$4,527.43
|
| Rate for Payer: HFN Commercial |
$4,680.04
|
| Rate for Payer: Multiplan Commercial |
$4,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,052.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,680.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,492.63
|
| Rate for Payer: Quartz Commercial |
$3,052.20
|
| Rate for Payer: WEA Trust Commercial |
$2,797.85
|
| Rate for Payer: WPS Commercial |
$3,767.94
|
|
|
REAMER CONCAVE 16MM XFR004116
|
Facility
|
OP
|
$5,087.00
|
|
| Hospital Charge Code |
5804044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,424.36 |
| Max. Negotiated Rate |
$20,348.00 |
| Rate for Payer: Aetna Commercial |
$4,578.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,374.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,424.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,306.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,543.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,441.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,696.11
|
| Rate for Payer: Cash Price |
$1,526.10
|
| Rate for Payer: Cigna Commercial |
$4,680.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,846.69
|
| Rate for Payer: Health EOS Commercial |
$4,527.43
|
| Rate for Payer: HFN Commercial |
$4,680.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,815.25
|
| Rate for Payer: Multiplan Commercial |
$4,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,052.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,680.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,492.63
|
| Rate for Payer: Quartz Commercial |
$3,306.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,052.20
|
| Rate for Payer: The Alliance Commercial |
$20,348.00
|
| Rate for Payer: WEA Trust Commercial |
$2,797.85
|
| Rate for Payer: WPS Commercial |
$3,767.94
|
|
|
REAMER CONCAVE 18MM XFR004118
|
Facility
|
OP
|
$4,857.00
|
|
| Hospital Charge Code |
5617675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,359.96 |
| Max. Negotiated Rate |
$19,428.00 |
| Rate for Payer: Aetna Commercial |
$4,371.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,177.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,359.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,157.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,331.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,574.21
|
| Rate for Payer: Cash Price |
$1,457.10
|
| Rate for Payer: Cigna Commercial |
$4,468.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,717.98
|
| Rate for Payer: Health EOS Commercial |
$4,322.73
|
| Rate for Payer: HFN Commercial |
$4,468.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,642.75
|
| Rate for Payer: Multiplan Commercial |
$3,885.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,914.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,468.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,379.93
|
| Rate for Payer: Quartz Commercial |
$3,157.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,914.20
|
| Rate for Payer: The Alliance Commercial |
$19,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,671.35
|
| Rate for Payer: WPS Commercial |
$3,597.58
|
|
|
REAMER CONCAVE 18MM XFR004118
|
Facility
|
IP
|
$4,857.00
|
|
| Hospital Charge Code |
5617675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,379.93 |
| Max. Negotiated Rate |
$4,468.44 |
| Rate for Payer: Aetna Commercial |
$4,371.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,177.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,574.21
|
| Rate for Payer: Cash Price |
$1,457.10
|
| Rate for Payer: Cigna Commercial |
$4,468.44
|
| Rate for Payer: Health EOS Commercial |
$4,322.73
|
| Rate for Payer: HFN Commercial |
$4,468.44
|
| Rate for Payer: Multiplan Commercial |
$3,885.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,914.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,468.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,379.93
|
| Rate for Payer: Quartz Commercial |
$2,914.20
|
| Rate for Payer: WEA Trust Commercial |
$2,671.35
|
| Rate for Payer: WPS Commercial |
$3,597.58
|
|
