|
DRILL 4 X 38 ROUND CARBIDE #E8140LSO
|
Facility
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.56 |
| Max. Negotiated Rate |
$6,408.00 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Aetna Managed Medicare |
$448.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,041.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$896.48
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.50
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$1,041.30
|
| Rate for Payer: Quartz Medicare Advantage |
$961.20
|
| Rate for Payer: The Alliance Commercial |
$6,408.00
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
DRILL 4X48 DIAMOND E5240
|
Facility
IP
|
$1,611.00
|
|
| Hospital Charge Code |
2964915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.39 |
| Max. Negotiated Rate |
$1,482.12 |
| Rate for Payer: Aetna Commercial |
$1,449.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$853.83
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna Commercial |
$1,482.12
|
| Rate for Payer: Health EOS Commercial |
$1,433.79
|
| Rate for Payer: HFN Commercial |
$1,482.12
|
| Rate for Payer: Multiplan Commercial |
$1,288.80
|
| Rate for Payer: NAPHCARE Commercial |
$966.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,482.12
|
| Rate for Payer: Quartz Beloit One Network |
$789.39
|
| Rate for Payer: Quartz Commercial |
$966.60
|
| Rate for Payer: WEA Trust Commercial |
$886.05
|
| Rate for Payer: WPS Commercial |
$1,193.27
|
|
|
DRILL 4X48 DIAMOND E5240
|
Facility
OP
|
$1,611.00
|
|
| Hospital Charge Code |
2964915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.08 |
| Max. Negotiated Rate |
$6,444.00 |
| Rate for Payer: Aetna Commercial |
$1,449.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,385.46
|
| Rate for Payer: Aetna Managed Medicare |
$451.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,047.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$805.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$773.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$853.83
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna Commercial |
$1,482.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$901.52
|
| Rate for Payer: Health EOS Commercial |
$1,433.79
|
| Rate for Payer: HFN Commercial |
$1,482.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,208.25
|
| Rate for Payer: Multiplan Commercial |
$1,288.80
|
| Rate for Payer: NAPHCARE Commercial |
$966.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,482.12
|
| Rate for Payer: Quartz Beloit One Network |
$789.39
|
| Rate for Payer: Quartz Commercial |
$1,047.15
|
| Rate for Payer: Quartz Medicare Advantage |
$966.60
|
| Rate for Payer: The Alliance Commercial |
$6,444.00
|
| Rate for Payer: WEA Trust Commercial |
$886.05
|
| Rate for Payer: WPS Commercial |
$1,193.27
|
|
|
DRILL AND PIN SET 2001-00-000
|
Facility
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2967461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$969.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
DRILL AND PIN SET 2001-00-000
|
Facility
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2967461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$6,460.00 |
| Rate for Payer: Aetna Commercial |
$1,453.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.95
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,485.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.75
|
| Rate for Payer: Health EOS Commercial |
$1,437.35
|
| Rate for Payer: HFN Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.25
|
| Rate for Payer: Multiplan Commercial |
$1,292.00
|
| Rate for Payer: NAPHCARE Commercial |
$969.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.80
|
| Rate for Payer: Quartz Beloit One Network |
$791.35
|
| Rate for Payer: Quartz Commercial |
$1,049.75
|
| Rate for Payer: Quartz Medicare Advantage |
$969.00
|
| Rate for Payer: The Alliance Commercial |
$6,460.00
|
| Rate for Payer: WEA Trust Commercial |
$888.25
|
| Rate for Payer: WPS Commercial |
$1,196.23
|
|
|
DRILL BIT
|
Facility
OP
|
$1,525.00
|
|
| Hospital Charge Code |
2965382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$6,100.00 |
| Rate for Payer: Aetna Commercial |
$1,372.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.50
|
| Rate for Payer: Aetna Managed Medicare |
$427.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.25
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.39
|
| Rate for Payer: Health EOS Commercial |
$1,357.25
|
| Rate for Payer: HFN Commercial |
$1,403.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.75
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$915.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$747.25
|
| Rate for Payer: Quartz Commercial |
$991.25
|
| Rate for Payer: Quartz Medicare Advantage |
$915.00
|
| Rate for Payer: The Alliance Commercial |
$6,100.00
|
| Rate for Payer: WEA Trust Commercial |
$838.75
|
| Rate for Payer: WPS Commercial |
$1,129.57
|
|
|
DRILL BIT
|
Facility
IP
|
$1,525.00
|
|
| Hospital Charge Code |
2965382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.25 |
| Max. Negotiated Rate |
$1,403.00 |
| Rate for Payer: Aetna Commercial |
$1,372.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.25
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,403.00
|
| Rate for Payer: Health EOS Commercial |
$1,357.25
|
| Rate for Payer: HFN Commercial |
$1,403.00
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$915.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$747.25
|
| Rate for Payer: Quartz Commercial |
$915.00
|
| Rate for Payer: WEA Trust Commercial |
$838.75
|
| Rate for Payer: WPS Commercial |
$1,129.57
|
|
|
DRILL BIT 0.76MM W 10MM STOP MINI 316.290
|
Facility
OP
|
$1,498.00
|
|
| Hospital Charge Code |
4508841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.44 |
| Max. Negotiated Rate |
$5,992.00 |
| Rate for Payer: Aetna Commercial |
$1,348.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.28
|
| Rate for Payer: Aetna Managed Medicare |
$419.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$973.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.94
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,378.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.28
|
| Rate for Payer: Health EOS Commercial |
$1,333.22
|
| Rate for Payer: HFN Commercial |
$1,378.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,123.50
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$898.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.16
|
| Rate for Payer: Quartz Beloit One Network |
$734.02
|
| Rate for Payer: Quartz Commercial |
$973.70
|
| Rate for Payer: Quartz Medicare Advantage |
$898.80
|
| Rate for Payer: The Alliance Commercial |
$5,992.00
|
| Rate for Payer: WEA Trust Commercial |
$823.90
|
| Rate for Payer: WPS Commercial |
$1,109.57
|
|
|
DRILL BIT 0.76MM W 10MM STOP MINI 316.290
|
Facility
IP
|
$1,498.00
|
|
| Hospital Charge Code |
4508841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.02 |
| Max. Negotiated Rate |
$1,378.16 |
| Rate for Payer: Aetna Commercial |
$1,348.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.94
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,378.16
|
| Rate for Payer: Health EOS Commercial |
$1,333.22
|
| Rate for Payer: HFN Commercial |
$1,378.16
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$898.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.16
|
| Rate for Payer: Quartz Beloit One Network |
$734.02
|
| Rate for Payer: Quartz Commercial |
$898.80
|
| Rate for Payer: WEA Trust Commercial |
$823.90
|
| Rate for Payer: WPS Commercial |
$1,109.57
|
|
|
DRILL BIT 1.0
|
Facility
OP
|
$1,220.00
|
|
| Hospital Charge Code |
2966172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$4,880.00 |
| Rate for Payer: Aetna Commercial |
$1,098.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,049.20
|
| Rate for Payer: Aetna Managed Medicare |
$341.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$793.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$610.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$585.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.60
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$1,122.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.71
|
| Rate for Payer: Health EOS Commercial |
$1,085.80
|
| Rate for Payer: HFN Commercial |
$1,122.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$915.00
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: NAPHCARE Commercial |
$732.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,122.40
|
| Rate for Payer: Quartz Beloit One Network |
$597.80
|
| Rate for Payer: Quartz Commercial |
$793.00
|
| Rate for Payer: Quartz Medicare Advantage |
$732.00
|
| Rate for Payer: The Alliance Commercial |
$4,880.00
|
| Rate for Payer: WEA Trust Commercial |
$671.00
|
| Rate for Payer: WPS Commercial |
$903.65
|
|
|
DRILL BIT 1.0
|
Facility
IP
|
$1,220.00
|
|
| Hospital Charge Code |
2966172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$1,122.40 |
| Rate for Payer: Aetna Commercial |
$1,098.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.60
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$1,122.40
|
| Rate for Payer: Health EOS Commercial |
$1,085.80
|
| Rate for Payer: HFN Commercial |
$1,122.40
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: NAPHCARE Commercial |
$732.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,122.40
|
| Rate for Payer: Quartz Beloit One Network |
$597.80
|
| Rate for Payer: Quartz Commercial |
$732.00
|
| Rate for Payer: WEA Trust Commercial |
$671.00
|
| Rate for Payer: WPS Commercial |
$903.65
|
|
|
DRILL BIT 10MM CANN TAPERED 03.037.021
|
Facility
OP
|
$5,063.00
|
|
| Hospital Charge Code |
5248872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,417.64 |
| Max. Negotiated Rate |
$20,252.00 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,417.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,290.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,531.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,430.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,797.25
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,037.80
|
| Rate for Payer: The Alliance Commercial |
$20,252.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
DRILL BIT 10MM CANN TAPERED 03.037.021
|
Facility
IP
|
$5,063.00
|
|
| Hospital Charge Code |
5248872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
DRILL BIT 1.0MM (MINI QUICK COUPLING FOR THREADED HOLE) 03.130.102
|
Facility
OP
|
$1,394.00
|
|
| Hospital Charge Code |
6173402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.32 |
| Max. Negotiated Rate |
$5,576.00 |
| Rate for Payer: Aetna Commercial |
$1,254.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,198.84
|
| Rate for Payer: Aetna Managed Medicare |
$390.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$906.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$697.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$669.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$738.82
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$1,282.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$780.08
|
| Rate for Payer: Health EOS Commercial |
$1,240.66
|
| Rate for Payer: HFN Commercial |
$1,282.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,045.50
|
| Rate for Payer: Multiplan Commercial |
$1,115.20
|
| Rate for Payer: NAPHCARE Commercial |
$836.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.48
|
| Rate for Payer: Quartz Beloit One Network |
$683.06
|
| Rate for Payer: Quartz Commercial |
$906.10
|
| Rate for Payer: Quartz Medicare Advantage |
$836.40
|
| Rate for Payer: The Alliance Commercial |
$5,576.00
|
| Rate for Payer: WEA Trust Commercial |
$766.70
|
| Rate for Payer: WPS Commercial |
$1,032.54
|
|
|
DRILL BIT 1.0MM (MINI QUICK COUPLING FOR THREADED HOLE) 03.130.102
|
Facility
IP
|
$1,394.00
|
|
| Hospital Charge Code |
6173402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.06 |
| Max. Negotiated Rate |
$1,282.48 |
| Rate for Payer: Aetna Commercial |
$1,254.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$738.82
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$1,282.48
|
| Rate for Payer: Health EOS Commercial |
$1,240.66
|
| Rate for Payer: HFN Commercial |
$1,282.48
|
| Rate for Payer: Multiplan Commercial |
$1,115.20
|
| Rate for Payer: NAPHCARE Commercial |
$836.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.48
|
| Rate for Payer: Quartz Beloit One Network |
$683.06
|
| Rate for Payer: Quartz Commercial |
$836.40
|
| Rate for Payer: WEA Trust Commercial |
$766.70
|
| Rate for Payer: WPS Commercial |
$1,032.54
|
|
|
DRILL BIT 1.0MMX50MM MINI QC 316.396
|
Facility
IP
|
$893.00
|
|
| Hospital Charge Code |
4391066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$437.57 |
| Max. Negotiated Rate |
$821.56 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$473.29
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cigna Commercial |
$821.56
|
| Rate for Payer: Health EOS Commercial |
$794.77
|
| Rate for Payer: HFN Commercial |
$821.56
|
| Rate for Payer: Multiplan Commercial |
$714.40
|
| Rate for Payer: NAPHCARE Commercial |
$535.80
|
| Rate for Payer: Preferred Network Access Commercial |
$821.56
|
| Rate for Payer: Quartz Beloit One Network |
$437.57
|
| Rate for Payer: Quartz Commercial |
$535.80
|
| Rate for Payer: WEA Trust Commercial |
$491.15
|
| Rate for Payer: WPS Commercial |
$661.45
|
|
|
DRILL BIT 1.0MMX50MM MINI QC 316.396
|
Facility
OP
|
$893.00
|
|
| Hospital Charge Code |
4391066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.04 |
| Max. Negotiated Rate |
$3,572.00 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$767.98
|
| Rate for Payer: Aetna Managed Medicare |
$250.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$580.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$446.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$428.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$473.29
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cigna Commercial |
$821.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$499.72
|
| Rate for Payer: Health EOS Commercial |
$794.77
|
| Rate for Payer: HFN Commercial |
$821.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$669.75
|
| Rate for Payer: Multiplan Commercial |
$714.40
|
| Rate for Payer: NAPHCARE Commercial |
$535.80
|
| Rate for Payer: Preferred Network Access Commercial |
$821.56
|
| Rate for Payer: Quartz Beloit One Network |
$437.57
|
| Rate for Payer: Quartz Commercial |
$580.45
|
| Rate for Payer: Quartz Medicare Advantage |
$535.80
|
| Rate for Payer: The Alliance Commercial |
$3,572.00
|
| Rate for Payer: WEA Trust Commercial |
$491.15
|
| Rate for Payer: WPS Commercial |
$661.45
|
|
|
DRILL BIT 1.0MM X 61MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.101
|
Facility
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.04 |
| Max. Negotiated Rate |
$1,235.56 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.98
|
| Rate for Payer: Aetna Managed Medicare |
$376.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.79
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,235.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.54
|
| Rate for Payer: Health EOS Commercial |
$1,195.27
|
| Rate for Payer: HFN Commercial |
$1,235.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,007.25
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$805.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.56
|
| Rate for Payer: Quartz Beloit One Network |
$658.07
|
| Rate for Payer: Quartz Commercial |
$872.95
|
| Rate for Payer: Quartz Medicare Advantage |
$805.80
|
| Rate for Payer: WEA Trust Commercial |
$738.65
|
| Rate for Payer: WPS Commercial |
$994.76
|
|
|
DRILL BIT 1.0MM X 61MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.101
|
Facility
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.07 |
| Max. Negotiated Rate |
$1,235.56 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.79
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,235.56
|
| Rate for Payer: Health EOS Commercial |
$1,195.27
|
| Rate for Payer: HFN Commercial |
$1,235.56
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$805.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.56
|
| Rate for Payer: Quartz Beloit One Network |
$658.07
|
| Rate for Payer: Quartz Commercial |
$805.80
|
| Rate for Payer: WEA Trust Commercial |
$738.65
|
| Rate for Payer: WPS Commercial |
$994.76
|
|
|
DRILL BIT 11.2 CANN LRG QC 03.233.002
|
Facility
OP
|
$5,930.00
|
|
| Hospital Charge Code |
6202968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,660.40 |
| Max. Negotiated Rate |
$23,720.00 |
| Rate for Payer: Aetna Commercial |
$5,337.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,099.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,660.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,854.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,965.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,846.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.90
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$5,455.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,318.43
|
| Rate for Payer: Health EOS Commercial |
$5,277.70
|
| Rate for Payer: HFN Commercial |
$5,455.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,447.50
|
| Rate for Payer: Multiplan Commercial |
$4,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,558.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,455.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.70
|
| Rate for Payer: Quartz Commercial |
$3,854.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,558.00
|
| Rate for Payer: The Alliance Commercial |
$23,720.00
|
| Rate for Payer: WEA Trust Commercial |
$3,261.50
|
| Rate for Payer: WPS Commercial |
$4,392.35
|
|
|
DRILL BIT 11.2 CANN LRG QC 03.233.002
|
Facility
IP
|
$5,930.00
|
|
| Hospital Charge Code |
6202968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,905.70 |
| Max. Negotiated Rate |
$5,455.60 |
| Rate for Payer: Aetna Commercial |
$5,337.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.90
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$5,455.60
|
| Rate for Payer: Health EOS Commercial |
$5,277.70
|
| Rate for Payer: HFN Commercial |
$5,455.60
|
| Rate for Payer: Multiplan Commercial |
$4,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,558.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,455.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.70
|
| Rate for Payer: Quartz Commercial |
$3,558.00
|
| Rate for Payer: WEA Trust Commercial |
$3,261.50
|
| Rate for Payer: WPS Commercial |
$4,392.35
|
|
|
DRILL BIT 1.1MM 310.11
|
Facility
IP
|
$1,424.00
|
|
| Hospital Charge Code |
2966173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.76 |
| Max. Negotiated Rate |
$1,310.08 |
| Rate for Payer: Aetna Commercial |
$1,281.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.72
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,310.08
|
| Rate for Payer: Health EOS Commercial |
$1,267.36
|
| Rate for Payer: HFN Commercial |
$1,310.08
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.08
|
| Rate for Payer: Quartz Beloit One Network |
$697.76
|
| Rate for Payer: Quartz Commercial |
$854.40
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
DRILL BIT 1.1MM 310.11
|
Facility
OP
|
$1,424.00
|
|
| Hospital Charge Code |
2966173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.72 |
| Max. Negotiated Rate |
$5,696.00 |
| Rate for Payer: Aetna Commercial |
$1,281.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| Rate for Payer: Aetna Managed Medicare |
$398.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$925.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.72
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,310.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.87
|
| Rate for Payer: Health EOS Commercial |
$1,267.36
|
| Rate for Payer: HFN Commercial |
$1,310.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.00
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.08
|
| Rate for Payer: Quartz Beloit One Network |
$697.76
|
| Rate for Payer: Quartz Commercial |
$925.60
|
| Rate for Payer: Quartz Medicare Advantage |
$854.40
|
| Rate for Payer: The Alliance Commercial |
$5,696.00
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
DRILL BIT 1.1MM 75MM 03.114.007
|
Facility
OP
|
$1,692.00
|
|
| Hospital Charge Code |
2966174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.76 |
| Max. Negotiated Rate |
$6,768.00 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$473.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,015.20
|
| Rate for Payer: The Alliance Commercial |
$6,768.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
DRILL BIT 1.1MM 75MM 03.114.007
|
Facility
IP
|
$1,692.00
|
|
| Hospital Charge Code |
2966174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
