|
DRILL BIT 2.0/2.4 PROXIMAL CORTEX 316-0316
|
Facility
IP
|
$2,897.00
|
|
| Hospital Charge Code |
2965445
|
|
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 2.0/2.4 PROXIMAL CORTEX 316-0316
|
Facility
OP
|
$2,897.00
|
|
| Hospital Charge Code |
2965445
|
|
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 2.0 ACUMED QUICK COUPLER 80-0317
|
Facility
OP
|
$2,266.00
|
|
| Hospital Charge Code |
5459104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$634.48 |
| Max. Negotiated Rate |
$9,064.00 |
| Rate for Payer: Aetna Commercial |
$2,039.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.76
|
| Rate for Payer: Aetna Managed Medicare |
$634.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,472.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,133.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,200.98
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$2,084.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,268.05
|
| Rate for Payer: Health EOS Commercial |
$2,016.74
|
| Rate for Payer: HFN Commercial |
$2,084.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,699.50
|
| Rate for Payer: Multiplan Commercial |
$1,812.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.34
|
| Rate for Payer: Quartz Commercial |
$1,472.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.60
|
| Rate for Payer: The Alliance Commercial |
$9,064.00
|
| Rate for Payer: WEA Trust Commercial |
$1,246.30
|
| Rate for Payer: WPS Commercial |
$1,678.43
|
|
|
DRILL BIT 2.0 ACUMED QUICK COUPLER 80-0317
|
Facility
IP
|
$2,266.00
|
|
| Hospital Charge Code |
5459104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,110.34 |
| Max. Negotiated Rate |
$2,084.72 |
| Rate for Payer: Aetna Commercial |
$2,039.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,200.98
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$2,084.72
|
| Rate for Payer: Health EOS Commercial |
$2,016.74
|
| Rate for Payer: HFN Commercial |
$2,084.72
|
| Rate for Payer: Multiplan Commercial |
$1,812.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.34
|
| Rate for Payer: Quartz Commercial |
$1,359.60
|
| Rate for Payer: WEA Trust Commercial |
$1,246.30
|
| Rate for Payer: WPS Commercial |
$1,678.43
|
|
|
DRILL BIT 2.0 (AO) AR-8944-22
|
Facility
OP
|
$1,357.00
|
|
| Hospital Charge Code |
5459676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.96 |
| Max. Negotiated Rate |
$5,428.00 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.02
|
| Rate for Payer: Aetna Managed Medicare |
$379.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$678.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.21
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,248.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.38
|
| Rate for Payer: Health EOS Commercial |
$1,207.73
|
| Rate for Payer: HFN Commercial |
$1,248.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,017.75
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$814.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.44
|
| Rate for Payer: Quartz Beloit One Network |
$664.93
|
| Rate for Payer: Quartz Commercial |
$882.05
|
| Rate for Payer: Quartz Medicare Advantage |
$814.20
|
| Rate for Payer: The Alliance Commercial |
$5,428.00
|
| Rate for Payer: WEA Trust Commercial |
$746.35
|
| Rate for Payer: WPS Commercial |
$1,005.13
|
|
|
DRILL BIT 2.0 (AO) AR-8944-22
|
Facility
IP
|
$1,357.00
|
|
| Hospital Charge Code |
5459676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.93 |
| Max. Negotiated Rate |
$1,248.44 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.21
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,248.44
|
| Rate for Payer: Health EOS Commercial |
$1,207.73
|
| Rate for Payer: HFN Commercial |
$1,248.44
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$814.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.44
|
| Rate for Payer: Quartz Beloit One Network |
$664.93
|
| Rate for Payer: Quartz Commercial |
$814.20
|
| Rate for Payer: WEA Trust Commercial |
$746.35
|
| Rate for Payer: WPS Commercial |
$1,005.13
|
|
|
DRILL BIT 2.0MM CALIBRATED AR-8943-16
|
Facility
OP
|
$1,517.00
|
|
| Hospital Charge Code |
4509013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.76 |
| Max. Negotiated Rate |
$6,068.00 |
| Rate for Payer: Aetna Commercial |
$1,365.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.62
|
| Rate for Payer: Aetna Managed Medicare |
$424.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$986.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$728.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.01
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,395.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.91
|
| Rate for Payer: Health EOS Commercial |
$1,350.13
|
| Rate for Payer: HFN Commercial |
$1,395.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,137.75
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.64
|
| Rate for Payer: Quartz Beloit One Network |
$743.33
|
| Rate for Payer: Quartz Commercial |
$986.05
|
| Rate for Payer: Quartz Medicare Advantage |
$910.20
|
| Rate for Payer: The Alliance Commercial |
$6,068.00
|
| Rate for Payer: WEA Trust Commercial |
$834.35
|
| Rate for Payer: WPS Commercial |
$1,123.64
|
|
|
DRILL BIT 2.0MM CALIBRATED AR-8943-16
|
Facility
IP
|
$1,517.00
|
|
| Hospital Charge Code |
4509013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$743.33 |
| Max. Negotiated Rate |
$1,395.64 |
| Rate for Payer: Aetna Commercial |
$1,365.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.01
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,395.64
|
| Rate for Payer: Health EOS Commercial |
$1,350.13
|
| Rate for Payer: HFN Commercial |
$1,395.64
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.64
|
| Rate for Payer: Quartz Beloit One Network |
$743.33
|
| Rate for Payer: Quartz Commercial |
$910.20
|
| Rate for Payer: WEA Trust Commercial |
$834.35
|
| Rate for Payer: WPS Commercial |
$1,123.64
|
|
|
DRILL BIT 2.0MM CMP FT CALIBRATED AR-8737-34
|
Facility
IP
|
$2,596.00
|
|
| Hospital Charge Code |
5547456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,272.04 |
| Max. Negotiated Rate |
$2,388.32 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,557.60
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
DRILL BIT 2.0MM CMP FT CALIBRATED AR-8737-34
|
Facility
OP
|
$2,596.00
|
|
| Hospital Charge Code |
5547456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.88 |
| Max. Negotiated Rate |
$10,384.00 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Aetna Managed Medicare |
$726.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.00
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,687.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.60
|
| Rate for Payer: The Alliance Commercial |
$10,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
DRILL BIT 2.0MM QUICKFIX AR-8930D-13
|
Facility
IP
|
$1,531.00
|
|
| Hospital Charge Code |
5415011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
DRILL BIT 2.0MM QUICKFIX AR-8930D-13
|
Facility
OP
|
$1,531.00
|
|
| Hospital Charge Code |
5415011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
DRILL BIT 2.0MM X 105MM AO SCALED STRYKER 705134
|
Facility
IP
|
$2,248.00
|
|
| Hospital Charge Code |
5685724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,101.52 |
| Max. Negotiated Rate |
$2,068.16 |
| Rate for Payer: Aetna Commercial |
$2,023.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.44
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,068.16
|
| Rate for Payer: Health EOS Commercial |
$2,000.72
|
| Rate for Payer: HFN Commercial |
$2,068.16
|
| Rate for Payer: Multiplan Commercial |
$1,798.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,348.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.52
|
| Rate for Payer: Quartz Commercial |
$1,348.80
|
| Rate for Payer: WEA Trust Commercial |
$1,236.40
|
| Rate for Payer: WPS Commercial |
$1,665.09
|
|
|
DRILL BIT 2.0MM X 105MM AO SCALED STRYKER 705134
|
Facility
OP
|
$2,248.00
|
|
| Hospital Charge Code |
5685724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.44 |
| Max. Negotiated Rate |
$8,992.00 |
| Rate for Payer: Aetna Commercial |
$2,023.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.28
|
| Rate for Payer: Aetna Managed Medicare |
$629.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.44
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,068.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,257.98
|
| Rate for Payer: Health EOS Commercial |
$2,000.72
|
| Rate for Payer: HFN Commercial |
$2,068.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.00
|
| Rate for Payer: Multiplan Commercial |
$1,798.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,348.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.52
|
| Rate for Payer: Quartz Commercial |
$1,461.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,348.80
|
| Rate for Payer: The Alliance Commercial |
$8,992.00
|
| Rate for Payer: WEA Trust Commercial |
$1,236.40
|
| Rate for Payer: WPS Commercial |
$1,665.09
|
|
|
DRILL BIT 2.0MM X12.7CM 5/64 00-2318-020-06
|
Facility
OP
|
$908.00
|
|
| Hospital Charge Code |
2967402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.24 |
| Max. Negotiated Rate |
$3,632.00 |
| Rate for Payer: Aetna Commercial |
$817.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$780.88
|
| Rate for Payer: Aetna Managed Medicare |
$254.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$590.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$454.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$435.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.24
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$835.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.12
|
| Rate for Payer: Health EOS Commercial |
$808.12
|
| Rate for Payer: HFN Commercial |
$835.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$681.00
|
| Rate for Payer: Multiplan Commercial |
$726.40
|
| Rate for Payer: NAPHCARE Commercial |
$544.80
|
| Rate for Payer: Preferred Network Access Commercial |
$835.36
|
| Rate for Payer: Quartz Beloit One Network |
$444.92
|
| Rate for Payer: Quartz Commercial |
$590.20
|
| Rate for Payer: Quartz Medicare Advantage |
$544.80
|
| Rate for Payer: The Alliance Commercial |
$3,632.00
|
| Rate for Payer: WEA Trust Commercial |
$499.40
|
| Rate for Payer: WPS Commercial |
$672.56
|
|
|
DRILL BIT 2.0MM X12.7CM 5/64 00-2318-020-06
|
Facility
IP
|
$908.00
|
|
| Hospital Charge Code |
2967402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.92 |
| Max. Negotiated Rate |
$835.36 |
| Rate for Payer: Aetna Commercial |
$817.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.24
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$835.36
|
| Rate for Payer: Health EOS Commercial |
$808.12
|
| Rate for Payer: HFN Commercial |
$835.36
|
| Rate for Payer: Multiplan Commercial |
$726.40
|
| Rate for Payer: NAPHCARE Commercial |
$544.80
|
| Rate for Payer: Preferred Network Access Commercial |
$835.36
|
| Rate for Payer: Quartz Beloit One Network |
$444.92
|
| Rate for Payer: Quartz Commercial |
$544.80
|
| Rate for Payer: WEA Trust Commercial |
$499.40
|
| Rate for Payer: WPS Commercial |
$672.56
|
|
|
DRILL BIT 2.0MM X 135MM AO COUPLING STRYKER 703690
|
Facility
IP
|
$2,794.00
|
|
| Hospital Charge Code |
5415595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,369.06 |
| Max. Negotiated Rate |
$2,570.48 |
| Rate for Payer: Aetna Commercial |
$2,514.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.82
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$2,570.48
|
| Rate for Payer: Health EOS Commercial |
$2,486.66
|
| Rate for Payer: HFN Commercial |
$2,570.48
|
| Rate for Payer: Multiplan Commercial |
$2,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.06
|
| Rate for Payer: Quartz Commercial |
$1,676.40
|
| Rate for Payer: WEA Trust Commercial |
$1,536.70
|
| Rate for Payer: WPS Commercial |
$2,069.52
|
|
|
DRILL BIT 2.0MM X 135MM AO COUPLING STRYKER 703690
|
Facility
OP
|
$2,794.00
|
|
| Hospital Charge Code |
5415595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$782.32 |
| Max. Negotiated Rate |
$11,176.00 |
| Rate for Payer: Aetna Commercial |
$2,514.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,402.84
|
| Rate for Payer: Aetna Managed Medicare |
$782.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,816.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,397.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,341.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.82
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$2,570.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,563.52
|
| Rate for Payer: Health EOS Commercial |
$2,486.66
|
| Rate for Payer: HFN Commercial |
$2,570.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,095.50
|
| Rate for Payer: Multiplan Commercial |
$2,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.06
|
| Rate for Payer: Quartz Commercial |
$1,816.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,676.40
|
| Rate for Payer: The Alliance Commercial |
$11,176.00
|
| Rate for Payer: WEA Trust Commercial |
$1,536.70
|
| Rate for Payer: WPS Commercial |
$2,069.52
|
|
|
DRILL BIT 2.0MM X 135MM SCALED STRYKER 703896
|
Facility
IP
|
$1,346.00
|
|
| Hospital Charge Code |
5458927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.54 |
| Max. Negotiated Rate |
$1,238.32 |
| Rate for Payer: Aetna Commercial |
$1,211.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.38
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,238.32
|
| Rate for Payer: Health EOS Commercial |
$1,197.94
|
| Rate for Payer: HFN Commercial |
$1,238.32
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$807.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.32
|
| Rate for Payer: Quartz Beloit One Network |
$659.54
|
| Rate for Payer: Quartz Commercial |
$807.60
|
| Rate for Payer: WEA Trust Commercial |
$740.30
|
| Rate for Payer: WPS Commercial |
$996.98
|
|
|
DRILL BIT 2.0MM X 135MM SCALED STRYKER 703896
|
Facility
OP
|
$1,346.00
|
|
| Hospital Charge Code |
5458927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.88 |
| Max. Negotiated Rate |
$5,384.00 |
| Rate for Payer: Aetna Commercial |
$1,211.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.56
|
| Rate for Payer: Aetna Managed Medicare |
$376.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.38
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,238.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.22
|
| Rate for Payer: Health EOS Commercial |
$1,197.94
|
| Rate for Payer: HFN Commercial |
$1,238.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,009.50
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$807.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.32
|
| Rate for Payer: Quartz Beloit One Network |
$659.54
|
| Rate for Payer: Quartz Commercial |
$874.90
|
| Rate for Payer: Quartz Medicare Advantage |
$807.60
|
| Rate for Payer: The Alliance Commercial |
$5,384.00
|
| Rate for Payer: WEA Trust Commercial |
$740.30
|
| Rate for Payer: WPS Commercial |
$996.98
|
|
|
DRILL BIT 2.0MM X 30MM 58820025
|
Facility
IP
|
$2,582.00
|
|
| Hospital Charge Code |
6089648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,265.18 |
| Max. Negotiated Rate |
$2,375.44 |
| Rate for Payer: Aetna Commercial |
$2,323.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,368.46
|
| Rate for Payer: Cash Price |
$774.60
|
| Rate for Payer: Cigna Commercial |
$2,375.44
|
| Rate for Payer: Health EOS Commercial |
$2,297.98
|
| Rate for Payer: HFN Commercial |
$2,375.44
|
| Rate for Payer: Multiplan Commercial |
$2,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,549.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,375.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.18
|
| Rate for Payer: Quartz Commercial |
$1,549.20
|
| Rate for Payer: WEA Trust Commercial |
$1,420.10
|
| Rate for Payer: WPS Commercial |
$1,912.49
|
|
|
DRILL BIT 2.0MM X 30MM 58820025
|
Facility
OP
|
$2,582.00
|
|
| Hospital Charge Code |
6089648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$722.96 |
| Max. Negotiated Rate |
$10,328.00 |
| Rate for Payer: Aetna Commercial |
$2,323.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,220.52
|
| Rate for Payer: Aetna Managed Medicare |
$722.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,678.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,239.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,368.46
|
| Rate for Payer: Cash Price |
$774.60
|
| Rate for Payer: Cigna Commercial |
$2,375.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,444.89
|
| Rate for Payer: Health EOS Commercial |
$2,297.98
|
| Rate for Payer: HFN Commercial |
$2,375.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,936.50
|
| Rate for Payer: Multiplan Commercial |
$2,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,549.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,375.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.18
|
| Rate for Payer: Quartz Commercial |
$1,678.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,549.20
|
| Rate for Payer: The Alliance Commercial |
$10,328.00
|
| Rate for Payer: WEA Trust Commercial |
$1,420.10
|
| Rate for Payer: WPS Commercial |
$1,912.49
|
|
|
DRILL BIT 2.0MM X 57MM (MINI QUICK COUPLING FOR GLIDING HOLE) 03.130.312
|
Facility
OP
|
$1,340.00
|
|
| Hospital Charge Code |
6181465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$5,360.00 |
| Rate for Payer: Aetna Commercial |
$1,206.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.40
|
| Rate for Payer: Aetna Managed Medicare |
$375.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$871.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$670.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$643.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.20
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,232.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$749.86
|
| Rate for Payer: Health EOS Commercial |
$1,192.60
|
| Rate for Payer: HFN Commercial |
$1,232.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: NAPHCARE Commercial |
$804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.80
|
| Rate for Payer: Quartz Beloit One Network |
$656.60
|
| Rate for Payer: Quartz Commercial |
$871.00
|
| Rate for Payer: Quartz Medicare Advantage |
$804.00
|
| Rate for Payer: The Alliance Commercial |
$5,360.00
|
| Rate for Payer: WEA Trust Commercial |
$737.00
|
| Rate for Payer: WPS Commercial |
$992.54
|
|
|
DRILL BIT 2.0MM X 57MM (MINI QUICK COUPLING FOR GLIDING HOLE) 03.130.312
|
Facility
IP
|
$1,340.00
|
|
| Hospital Charge Code |
6181465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.60 |
| Max. Negotiated Rate |
$1,232.80 |
| Rate for Payer: Aetna Commercial |
$1,206.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.20
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,232.80
|
| Rate for Payer: Health EOS Commercial |
$1,192.60
|
| Rate for Payer: HFN Commercial |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: NAPHCARE Commercial |
$804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.80
|
| Rate for Payer: Quartz Beloit One Network |
$656.60
|
| Rate for Payer: Quartz Commercial |
$804.00
|
| Rate for Payer: WEA Trust Commercial |
$737.00
|
| Rate for Payer: WPS Commercial |
$992.54
|
|
|
DRILL BIT 2.0 QUICK COUPLER
|
Facility
IP
|
$1,390.00
|
|
| Hospital Charge Code |
2964138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$1,278.80 |
| Rate for Payer: Aetna Commercial |
$1,251.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.70
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$1,278.80
|
| Rate for Payer: Health EOS Commercial |
$1,237.10
|
| Rate for Payer: HFN Commercial |
$1,278.80
|
| Rate for Payer: Multiplan Commercial |
$1,112.00
|
| Rate for Payer: NAPHCARE Commercial |
$834.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,278.80
|
| Rate for Payer: Quartz Beloit One Network |
$681.10
|
| Rate for Payer: Quartz Commercial |
$834.00
|
| Rate for Payer: WEA Trust Commercial |
$764.50
|
| Rate for Payer: WPS Commercial |
$1,029.57
|
|
