|
REAMER CONE 20MM XFR004220
|
Facility
|
IP
|
$1,907.00
|
|
| Hospital Charge Code |
2967968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.43 |
| Max. Negotiated Rate |
$1,754.44 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,144.20
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
REAMER CONE 20MM XFR004220
|
Facility
|
OP
|
$1,907.00
|
|
| Hospital Charge Code |
2967968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.96 |
| Max. Negotiated Rate |
$7,628.00 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Aetna Managed Medicare |
$533.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,239.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$953.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.16
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,430.25
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,239.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.20
|
| Rate for Payer: The Alliance Commercial |
$7,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
REAMER CONE 22MM XFR004222
|
Facility
|
OP
|
$5,087.00
|
|
| Hospital Charge Code |
5831733
|
|
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 CONE 22MM XFR004222
|
Facility
|
IP
|
$5,087.00
|
|
| Hospital Charge Code |
5831733
|
|
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 CONE MTP 16MM GEN 2 455 SS 58890216
|
Facility
|
IP
|
$2,111.00
|
|
| Hospital Charge Code |
6206991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,034.39 |
| Max. Negotiated Rate |
$1,942.12 |
| Rate for Payer: Aetna Commercial |
$1,899.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,815.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.83
|
| Rate for Payer: Cash Price |
$633.30
|
| Rate for Payer: Cigna Commercial |
$1,942.12
|
| Rate for Payer: Health EOS Commercial |
$1,878.79
|
| Rate for Payer: HFN Commercial |
$1,942.12
|
| Rate for Payer: Multiplan Commercial |
$1,688.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,266.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,942.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.39
|
| Rate for Payer: Quartz Commercial |
$1,266.60
|
| Rate for Payer: WEA Trust Commercial |
$1,161.05
|
| Rate for Payer: WPS Commercial |
$1,563.62
|
|
|
REAMER CONE MTP 16MM GEN 2 455 SS 58890216
|
Facility
|
OP
|
$2,111.00
|
|
| Hospital Charge Code |
6206991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.08 |
| Max. Negotiated Rate |
$8,444.00 |
| Rate for Payer: Aetna Commercial |
$1,899.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,815.46
|
| Rate for Payer: Aetna Managed Medicare |
$591.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,055.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.83
|
| Rate for Payer: Cash Price |
$633.30
|
| Rate for Payer: Cigna Commercial |
$1,942.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.32
|
| Rate for Payer: Health EOS Commercial |
$1,878.79
|
| Rate for Payer: HFN Commercial |
$1,942.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,583.25
|
| Rate for Payer: Multiplan Commercial |
$1,688.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,266.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,942.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.39
|
| Rate for Payer: Quartz Commercial |
$1,372.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,266.60
|
| Rate for Payer: The Alliance Commercial |
$8,444.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.05
|
| Rate for Payer: WPS Commercial |
$1,563.62
|
|
|
REAMER CONE MTP 18MM GEN 2 455 SS 58890218
|
Facility
|
OP
|
$2,298.00
|
|
| Hospital Charge Code |
6181324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.44 |
| Max. Negotiated Rate |
$9,192.00 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Aetna Managed Medicare |
$643.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,285.96
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.50
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,493.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,378.80
|
| Rate for Payer: The Alliance Commercial |
$9,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
REAMER CONE MTP 18MM GEN 2 455 SS 58890218
|
Facility
|
IP
|
$2,298.00
|
|
| Hospital Charge Code |
6181324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,126.02 |
| Max. Negotiated Rate |
$2,114.16 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,378.80
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
REAMER CONE MTP 20MM 58890220
|
Facility
|
OP
|
$3,322.00
|
|
| Hospital Charge Code |
5895658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$930.16 |
| Max. Negotiated Rate |
$13,288.00 |
| Rate for Payer: Aetna Commercial |
$2,989.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,856.92
|
| Rate for Payer: Aetna Managed Medicare |
$930.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,159.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,594.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,760.66
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$3,056.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,858.99
|
| Rate for Payer: Health EOS Commercial |
$2,956.58
|
| Rate for Payer: HFN Commercial |
$3,056.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,491.50
|
| Rate for Payer: Multiplan Commercial |
$2,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,993.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,056.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,627.78
|
| Rate for Payer: Quartz Commercial |
$2,159.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,993.20
|
| Rate for Payer: The Alliance Commercial |
$13,288.00
|
| Rate for Payer: WEA Trust Commercial |
$1,827.10
|
| Rate for Payer: WPS Commercial |
$2,460.61
|
|
|
REAMER CONE MTP 20MM 58890220
|
Facility
|
IP
|
$3,322.00
|
|
| Hospital Charge Code |
5895658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,627.78 |
| Max. Negotiated Rate |
$3,056.24 |
| Rate for Payer: Aetna Commercial |
$2,989.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,856.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,760.66
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$3,056.24
|
| Rate for Payer: Health EOS Commercial |
$2,956.58
|
| Rate for Payer: HFN Commercial |
$3,056.24
|
| Rate for Payer: Multiplan Commercial |
$2,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,993.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,056.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,627.78
|
| Rate for Payer: Quartz Commercial |
$1,993.20
|
| Rate for Payer: WEA Trust Commercial |
$1,827.10
|
| Rate for Payer: WPS Commercial |
$2,460.61
|
|
|
REAMER CONE MTP 22MM 58890222
|
Facility
|
OP
|
$2,402.00
|
|
| Hospital Charge Code |
6216986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.56 |
| Max. Negotiated Rate |
$9,608.00 |
| Rate for Payer: Aetna Commercial |
$2,161.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,065.72
|
| Rate for Payer: Aetna Managed Medicare |
$672.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,561.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.06
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,209.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,344.16
|
| Rate for Payer: Health EOS Commercial |
$2,137.78
|
| Rate for Payer: HFN Commercial |
$2,209.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,801.50
|
| Rate for Payer: Multiplan Commercial |
$1,921.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,441.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.98
|
| Rate for Payer: Quartz Commercial |
$1,561.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,441.20
|
| Rate for Payer: The Alliance Commercial |
$9,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,321.10
|
| Rate for Payer: WPS Commercial |
$1,779.16
|
|
|
REAMER CONE MTP 22MM 58890222
|
Facility
|
IP
|
$2,402.00
|
|
| Hospital Charge Code |
6216986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,176.98 |
| Max. Negotiated Rate |
$2,209.84 |
| Rate for Payer: Aetna Commercial |
$2,161.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,065.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.06
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,209.84
|
| Rate for Payer: Health EOS Commercial |
$2,137.78
|
| Rate for Payer: HFN Commercial |
$2,209.84
|
| Rate for Payer: Multiplan Commercial |
$1,921.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,441.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.98
|
| Rate for Payer: Quartz Commercial |
$1,441.20
|
| Rate for Payer: WEA Trust Commercial |
$1,321.10
|
| Rate for Payer: WPS Commercial |
$1,779.16
|
|
|
REAMER CONVEX 16MM XFR004216
|
Facility
|
IP
|
$5,087.00
|
|
| Hospital Charge Code |
5804045
|
|
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 CONVEX 16MM XFR004216
|
Facility
|
OP
|
$5,087.00
|
|
| Hospital Charge Code |
5804045
|
|
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 CONVEX 18MM XFR004218
|
Facility
|
IP
|
$4,857.00
|
|
| Hospital Charge Code |
5617676
|
|
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
|
|
|
REAMER CONVEX 18MM XFR004218
|
Facility
|
OP
|
$4,857.00
|
|
| Hospital Charge Code |
5617676
|
|
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 CUP 20MM XFR004120
|
Facility
|
IP
|
$6,250.00
|
|
| Hospital Charge Code |
5591288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,062.50 |
| Max. Negotiated Rate |
$5,750.00 |
| Rate for Payer: Aetna Commercial |
$5,625.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,375.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.50
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cigna Commercial |
$5,750.00
|
| Rate for Payer: Health EOS Commercial |
$5,562.50
|
| Rate for Payer: HFN Commercial |
$5,750.00
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,750.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.50
|
| Rate for Payer: Quartz Commercial |
$3,750.00
|
| Rate for Payer: WEA Trust Commercial |
$3,437.50
|
| Rate for Payer: WPS Commercial |
$4,629.38
|
|
|
REAMER CUP 20MM XFR004120
|
Facility
|
OP
|
$6,250.00
|
|
| Hospital Charge Code |
5591288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$25,000.00 |
| Rate for Payer: Aetna Commercial |
$5,625.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,375.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,750.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,125.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.50
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cigna Commercial |
$5,750.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.50
|
| Rate for Payer: Health EOS Commercial |
$5,562.50
|
| Rate for Payer: HFN Commercial |
$5,750.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.50
|
| Rate for Payer: Multiplan Commercial |
$5,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,750.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.50
|
| Rate for Payer: Quartz Commercial |
$4,062.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,750.00
|
| Rate for Payer: The Alliance Commercial |
$25,000.00
|
| Rate for Payer: WEA Trust Commercial |
$3,437.50
|
| Rate for Payer: WPS Commercial |
$4,629.38
|
|
|
REAMER CUP 22MM XFR004122
|
Facility
|
OP
|
$5,087.00
|
|
| Hospital Charge Code |
5831732
|
|
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 CUP 22MM XFR004122
|
Facility
|
IP
|
$5,087.00
|
|
| Hospital Charge Code |
5831732
|
|
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 CUP MTP 16MM GEN 2 455 SS 58890116
|
Facility
|
IP
|
$2,111.00
|
|
| Hospital Charge Code |
6206990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,034.39 |
| Max. Negotiated Rate |
$1,942.12 |
| Rate for Payer: Aetna Commercial |
$1,899.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,815.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.83
|
| Rate for Payer: Cash Price |
$633.30
|
| Rate for Payer: Cigna Commercial |
$1,942.12
|
| Rate for Payer: Health EOS Commercial |
$1,878.79
|
| Rate for Payer: HFN Commercial |
$1,942.12
|
| Rate for Payer: Multiplan Commercial |
$1,688.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,266.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,942.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.39
|
| Rate for Payer: Quartz Commercial |
$1,266.60
|
| Rate for Payer: WEA Trust Commercial |
$1,161.05
|
| Rate for Payer: WPS Commercial |
$1,563.62
|
|
|
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 |
$591.08 |
| Max. Negotiated Rate |
$8,444.00 |
| Rate for Payer: Aetna Commercial |
$1,899.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,815.46
|
| Rate for Payer: Aetna Managed Medicare |
$591.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,055.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.83
|
| Rate for Payer: Cash Price |
$633.30
|
| Rate for Payer: Cigna Commercial |
$1,942.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.32
|
| Rate for Payer: Health EOS Commercial |
$1,878.79
|
| Rate for Payer: HFN Commercial |
$1,942.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,583.25
|
| Rate for Payer: Multiplan Commercial |
$1,688.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,266.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,942.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.39
|
| Rate for Payer: Quartz Commercial |
$1,372.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,266.60
|
| Rate for Payer: The Alliance Commercial |
$8,444.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.05
|
| Rate for Payer: WPS Commercial |
$1,563.62
|
|
|
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 |
$852.88 |
| Max. Negotiated Rate |
$12,184.00 |
| Rate for Payer: Aetna Commercial |
$2,741.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.56
|
| Rate for Payer: Aetna Managed Medicare |
$852.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,979.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.38
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$2,802.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.54
|
| Rate for Payer: Health EOS Commercial |
$2,710.94
|
| Rate for Payer: HFN Commercial |
$2,802.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.50
|
| Rate for Payer: Multiplan Commercial |
$2,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.54
|
| Rate for Payer: Quartz Commercial |
$1,979.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,827.60
|
| Rate for Payer: The Alliance Commercial |
$12,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,675.30
|
| Rate for Payer: WPS Commercial |
$2,256.17
|
|
|
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 |
$1,492.54 |
| Max. Negotiated Rate |
$2,802.32 |
| Rate for Payer: Aetna Commercial |
$2,741.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.38
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$2,802.32
|
| Rate for Payer: Health EOS Commercial |
$2,710.94
|
| Rate for Payer: HFN Commercial |
$2,802.32
|
| Rate for Payer: Multiplan Commercial |
$2,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.54
|
| Rate for Payer: Quartz Commercial |
$1,827.60
|
| Rate for Payer: WEA Trust Commercial |
$1,675.30
|
| Rate for Payer: WPS Commercial |
$2,256.17
|
|
|
REAMER CUP MTP 20MM 58890120
|
Facility
|
IP
|
$3,322.00
|
|
| Hospital Charge Code |
5895657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,627.78 |
| Max. Negotiated Rate |
$3,056.24 |
| Rate for Payer: Aetna Commercial |
$2,989.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,856.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,760.66
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$3,056.24
|
| Rate for Payer: Health EOS Commercial |
$2,956.58
|
| Rate for Payer: HFN Commercial |
$3,056.24
|
| Rate for Payer: Multiplan Commercial |
$2,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,993.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,056.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,627.78
|
| Rate for Payer: Quartz Commercial |
$1,993.20
|
| Rate for Payer: WEA Trust Commercial |
$1,827.10
|
| Rate for Payer: WPS Commercial |
$2,460.61
|
|
