|
DRILL BIT 1.1MM J-LATCH 317.235.96
|
Facility
IP
|
$2,040.00
|
|
| Hospital Charge Code |
2966145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$999.60 |
| Max. Negotiated Rate |
$1,876.80 |
| Rate for Payer: Aetna Commercial |
$1,836.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,081.20
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,876.80
|
| Rate for Payer: Health EOS Commercial |
$1,815.60
|
| Rate for Payer: HFN Commercial |
$1,876.80
|
| Rate for Payer: Multiplan Commercial |
$1,632.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.80
|
| Rate for Payer: Quartz Beloit One Network |
$999.60
|
| Rate for Payer: Quartz Commercial |
$1,224.00
|
| Rate for Payer: WEA Trust Commercial |
$1,122.00
|
| Rate for Payer: WPS Commercial |
$1,511.03
|
|
|
DRILL BIT 1.1MM J-LATCH 317.235.96
|
Facility
OP
|
$2,040.00
|
|
| Hospital Charge Code |
2966145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$8,160.00 |
| Rate for Payer: Aetna Commercial |
$1,836.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,754.40
|
| Rate for Payer: Aetna Managed Medicare |
$571.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,326.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,020.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$979.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,081.20
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,876.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,141.58
|
| Rate for Payer: Health EOS Commercial |
$1,815.60
|
| Rate for Payer: HFN Commercial |
$1,876.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,530.00
|
| Rate for Payer: Multiplan Commercial |
$1,632.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.80
|
| Rate for Payer: Quartz Beloit One Network |
$999.60
|
| Rate for Payer: Quartz Commercial |
$1,326.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,224.00
|
| Rate for Payer: The Alliance Commercial |
$8,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,122.00
|
| Rate for Payer: WPS Commercial |
$1,511.03
|
|
|
DRILL BIT 1.1MM X12.7CM 00-2318-011-06
|
Facility
OP
|
$874.00
|
|
| Hospital Charge Code |
4097727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.72 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$751.64
|
| Rate for Payer: Aetna Managed Medicare |
$244.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$419.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.22
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$804.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.09
|
| Rate for Payer: Health EOS Commercial |
$777.86
|
| Rate for Payer: HFN Commercial |
$804.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$655.50
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: NAPHCARE Commercial |
$524.40
|
| Rate for Payer: Preferred Network Access Commercial |
$804.08
|
| Rate for Payer: Quartz Beloit One Network |
$428.26
|
| Rate for Payer: Quartz Commercial |
$568.10
|
| Rate for Payer: Quartz Medicare Advantage |
$524.40
|
| Rate for Payer: The Alliance Commercial |
$3,496.00
|
| Rate for Payer: WEA Trust Commercial |
$480.70
|
| Rate for Payer: WPS Commercial |
$647.37
|
|
|
DRILL BIT 1.1MM X12.7CM 00-2318-011-06
|
Facility
IP
|
$874.00
|
|
| Hospital Charge Code |
4097727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.26 |
| Max. Negotiated Rate |
$804.08 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.22
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$804.08
|
| Rate for Payer: Health EOS Commercial |
$777.86
|
| Rate for Payer: HFN Commercial |
$804.08
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: NAPHCARE Commercial |
$524.40
|
| Rate for Payer: Preferred Network Access Commercial |
$804.08
|
| Rate for Payer: Quartz Beloit One Network |
$428.26
|
| Rate for Payer: Quartz Commercial |
$524.40
|
| Rate for Payer: WEA Trust Commercial |
$480.70
|
| Rate for Payer: WPS Commercial |
$647.37
|
|
|
DRILL BIT 1.1MM X 65MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.201
|
Facility
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861729
|
|
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 1.1MM X 65MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.201
|
Facility
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861729
|
|
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 1.1x5.0 WITH STOP
|
Facility
OP
|
$2,075.00
|
|
| Hospital Charge Code |
2965250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$8,300.00 |
| Rate for Payer: Aetna Commercial |
$1,867.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,784.50
|
| Rate for Payer: Aetna Managed Medicare |
$581.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,348.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,037.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$996.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,099.75
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,161.17
|
| Rate for Payer: Health EOS Commercial |
$1,846.75
|
| Rate for Payer: HFN Commercial |
$1,909.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,556.25
|
| Rate for Payer: Multiplan Commercial |
$1,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,245.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,909.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,016.75
|
| Rate for Payer: Quartz Commercial |
$1,348.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,245.00
|
| Rate for Payer: The Alliance Commercial |
$8,300.00
|
| Rate for Payer: WEA Trust Commercial |
$1,141.25
|
| Rate for Payer: WPS Commercial |
$1,536.95
|
|
|
DRILL BIT 1.1x5.0 WITH STOP
|
Facility
IP
|
$2,075.00
|
|
| Hospital Charge Code |
2965250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,016.75 |
| Max. Negotiated Rate |
$1,909.00 |
| Rate for Payer: Aetna Commercial |
$1,867.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,099.75
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: Health EOS Commercial |
$1,846.75
|
| Rate for Payer: HFN Commercial |
$1,909.00
|
| Rate for Payer: Multiplan Commercial |
$1,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,245.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,909.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,016.75
|
| Rate for Payer: Quartz Commercial |
$1,245.00
|
| Rate for Payer: WEA Trust Commercial |
$1,141.25
|
| Rate for Payer: WPS Commercial |
$1,536.95
|
|
|
DRILL BIT 12.7m STEMMED TIBIAL
|
Facility
OP
|
$2,897.00
|
|
| Hospital Charge Code |
2967463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.16 |
| Max. Negotiated Rate |
$11,588.00 |
| Rate for Payer: Aetna Commercial |
$2,607.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.42
|
| Rate for Payer: Aetna Managed Medicare |
$811.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,883.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,448.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,390.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.41
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,665.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.16
|
| Rate for Payer: Health EOS Commercial |
$2,578.33
|
| Rate for Payer: HFN Commercial |
$2,665.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,172.75
|
| Rate for Payer: Multiplan Commercial |
$2,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.53
|
| Rate for Payer: Quartz Commercial |
$1,883.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.20
|
| Rate for Payer: The Alliance Commercial |
$11,588.00
|
| Rate for Payer: WEA Trust Commercial |
$1,593.35
|
| Rate for Payer: WPS Commercial |
$2,145.81
|
|
|
DRILL BIT 12.7m STEMMED TIBIAL
|
Facility
IP
|
$2,897.00
|
|
| Hospital Charge Code |
2967463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,419.53 |
| Max. Negotiated Rate |
$2,665.24 |
| Rate for Payer: Aetna Commercial |
$2,607.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.41
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,665.24
|
| Rate for Payer: Health EOS Commercial |
$2,578.33
|
| Rate for Payer: HFN Commercial |
$2,665.24
|
| Rate for Payer: Multiplan Commercial |
$2,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.53
|
| Rate for Payer: Quartz Commercial |
$1,738.20
|
| Rate for Payer: WEA Trust Commercial |
$1,593.35
|
| Rate for Payer: WPS Commercial |
$2,145.81
|
|
|
DRILL BIT 12.8 CALIBRATED LRG QC 03.233.001
|
Facility
OP
|
$6,167.00
|
|
| Hospital Charge Code |
6175470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,726.76 |
| Max. Negotiated Rate |
$24,668.00 |
| Rate for Payer: Aetna Commercial |
$5,550.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,303.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,726.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,008.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,083.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,960.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,268.51
|
| Rate for Payer: Cash Price |
$1,850.10
|
| Rate for Payer: Cigna Commercial |
$5,673.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,451.05
|
| Rate for Payer: Health EOS Commercial |
$5,488.63
|
| Rate for Payer: HFN Commercial |
$5,673.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,625.25
|
| Rate for Payer: Multiplan Commercial |
$4,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,700.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,673.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,021.83
|
| Rate for Payer: Quartz Commercial |
$4,008.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,700.20
|
| Rate for Payer: The Alliance Commercial |
$24,668.00
|
| Rate for Payer: WEA Trust Commercial |
$3,391.85
|
| Rate for Payer: WPS Commercial |
$4,567.90
|
|
|
DRILL BIT 12.8 CALIBRATED LRG QC 03.233.001
|
Facility
IP
|
$6,167.00
|
|
| Hospital Charge Code |
6175470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,021.83 |
| Max. Negotiated Rate |
$5,673.64 |
| Rate for Payer: Aetna Commercial |
$5,550.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,268.51
|
| Rate for Payer: Cash Price |
$1,850.10
|
| Rate for Payer: Cigna Commercial |
$5,673.64
|
| Rate for Payer: Health EOS Commercial |
$5,488.63
|
| Rate for Payer: HFN Commercial |
$5,673.64
|
| Rate for Payer: Multiplan Commercial |
$4,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,700.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,673.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,021.83
|
| Rate for Payer: Quartz Commercial |
$3,700.20
|
| Rate for Payer: WEA Trust Commercial |
$3,391.85
|
| Rate for Payer: WPS Commercial |
$4,567.90
|
|
|
DRILL BIT 1.3MM J-LATCH 316.335.96
|
Facility
OP
|
$2,137.00
|
|
| Hospital Charge Code |
2966146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.36 |
| Max. Negotiated Rate |
$8,548.00 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Aetna Managed Medicare |
$598.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,068.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,025.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,195.87
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,389.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.20
|
| Rate for Payer: The Alliance Commercial |
$8,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
DRILL BIT 1.3MM J-LATCH 316.335.96
|
Facility
IP
|
$2,137.00
|
|
| Hospital Charge Code |
2966146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,047.13 |
| Max. Negotiated Rate |
$1,966.04 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,282.20
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
DRILL BIT 1.3MM (MINI QUICK COUPLING FOR GLIDING HOLE) 03.130.112
|
Facility
IP
|
$1,394.00
|
|
| Hospital Charge Code |
6173405
|
|
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 1.3MM (MINI QUICK COUPLING FOR GLIDING HOLE) 03.130.112
|
Facility
OP
|
$1,394.00
|
|
| Hospital Charge Code |
6173405
|
|
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 1.3MM (STRYKER J-LATCH FOR GLIDING HOLE) 03.130.111
|
Facility
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861731
|
|
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 1.3MM (STRYKER J-LATCH FOR GLIDING HOLE) 03.130.111
|
Facility
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861731
|
|
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 1.3MMX55MM MINI QC 316.402
|
Facility
IP
|
$792.00
|
|
| Hospital Charge Code |
4508845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
DRILL BIT 1.3MMX55MM MINI QC 316.402
|
Facility
OP
|
$792.00
|
|
| Hospital Charge Code |
4508845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$475.20
|
| Rate for Payer: The Alliance Commercial |
$3,168.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
DRILL BIT 1.4MM X 27MM AO 60-14326
|
Facility
IP
|
$989.00
|
|
| Hospital Charge Code |
4595583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.61 |
| Max. Negotiated Rate |
$909.88 |
| Rate for Payer: Aetna Commercial |
$890.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.17
|
| Rate for Payer: Cash Price |
$296.70
|
| Rate for Payer: Cigna Commercial |
$909.88
|
| Rate for Payer: Health EOS Commercial |
$880.21
|
| Rate for Payer: HFN Commercial |
$909.88
|
| Rate for Payer: Multiplan Commercial |
$791.20
|
| Rate for Payer: NAPHCARE Commercial |
$593.40
|
| Rate for Payer: Preferred Network Access Commercial |
$909.88
|
| Rate for Payer: Quartz Beloit One Network |
$484.61
|
| Rate for Payer: Quartz Commercial |
$593.40
|
| Rate for Payer: WEA Trust Commercial |
$543.95
|
| Rate for Payer: WPS Commercial |
$732.55
|
|
|
DRILL BIT 1.4MM X 27MM AO 60-14326
|
Facility
OP
|
$989.00
|
|
| Hospital Charge Code |
4595583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.92 |
| Max. Negotiated Rate |
$3,956.00 |
| Rate for Payer: Aetna Commercial |
$890.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.54
|
| Rate for Payer: Aetna Managed Medicare |
$276.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.17
|
| Rate for Payer: Cash Price |
$296.70
|
| Rate for Payer: Cigna Commercial |
$909.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$553.44
|
| Rate for Payer: Health EOS Commercial |
$880.21
|
| Rate for Payer: HFN Commercial |
$909.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.75
|
| Rate for Payer: Multiplan Commercial |
$791.20
|
| Rate for Payer: NAPHCARE Commercial |
$593.40
|
| Rate for Payer: Preferred Network Access Commercial |
$909.88
|
| Rate for Payer: Quartz Beloit One Network |
$484.61
|
| Rate for Payer: Quartz Commercial |
$642.85
|
| Rate for Payer: Quartz Medicare Advantage |
$593.40
|
| Rate for Payer: The Alliance Commercial |
$3,956.00
|
| Rate for Payer: WEA Trust Commercial |
$543.95
|
| Rate for Payer: WPS Commercial |
$732.55
|
|
|
DRILL BIT 1.4 X 150MM ASNIS III 702448
|
Facility
OP
|
$1,467.00
|
|
| Hospital Charge Code |
6211057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.76 |
| Max. Negotiated Rate |
$5,868.00 |
| Rate for Payer: Aetna Commercial |
$1,320.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.62
|
| Rate for Payer: Aetna Managed Medicare |
$410.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$953.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$704.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.51
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,349.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.93
|
| Rate for Payer: Health EOS Commercial |
$1,305.63
|
| Rate for Payer: HFN Commercial |
$1,349.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,100.25
|
| Rate for Payer: Multiplan Commercial |
$1,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$880.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.64
|
| Rate for Payer: Quartz Beloit One Network |
$718.83
|
| Rate for Payer: Quartz Commercial |
$953.55
|
| Rate for Payer: Quartz Medicare Advantage |
$880.20
|
| Rate for Payer: The Alliance Commercial |
$5,868.00
|
| Rate for Payer: WEA Trust Commercial |
$806.85
|
| Rate for Payer: WPS Commercial |
$1,086.61
|
|
|
DRILL BIT 1.4 X 150MM ASNIS III 702448
|
Facility
IP
|
$1,467.00
|
|
| Hospital Charge Code |
6211057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.83 |
| Max. Negotiated Rate |
$1,349.64 |
| Rate for Payer: Aetna Commercial |
$1,320.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.51
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,349.64
|
| Rate for Payer: Health EOS Commercial |
$1,305.63
|
| Rate for Payer: HFN Commercial |
$1,349.64
|
| Rate for Payer: Multiplan Commercial |
$1,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$880.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.64
|
| Rate for Payer: Quartz Beloit One Network |
$718.83
|
| Rate for Payer: Quartz Commercial |
$880.20
|
| Rate for Payer: WEA Trust Commercial |
$806.85
|
| Rate for Payer: WPS Commercial |
$1,086.61
|
|
|
DRILL BIT 1.5MM 65MM MINI 310.141
|
Facility
OP
|
$1,423.00
|
|
| Hospital Charge Code |
2966176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.44 |
| Max. Negotiated Rate |
$5,692.00 |
| Rate for Payer: Aetna Commercial |
$1,280.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,223.78
|
| Rate for Payer: Aetna Managed Medicare |
$398.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$924.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$711.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.19
|
| Rate for Payer: Cash Price |
$426.90
|
| Rate for Payer: Cigna Commercial |
$1,309.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.31
|
| Rate for Payer: Health EOS Commercial |
$1,266.47
|
| Rate for Payer: HFN Commercial |
$1,309.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,067.25
|
| Rate for Payer: Multiplan Commercial |
$1,138.40
|
| Rate for Payer: NAPHCARE Commercial |
$853.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,309.16
|
| Rate for Payer: Quartz Beloit One Network |
$697.27
|
| Rate for Payer: Quartz Commercial |
$924.95
|
| Rate for Payer: Quartz Medicare Advantage |
$853.80
|
| Rate for Payer: The Alliance Commercial |
$5,692.00
|
| Rate for Payer: WEA Trust Commercial |
$782.65
|
| Rate for Payer: WPS Commercial |
$1,054.02
|
|
