|
DRILL BIT 2.4MM CLX CLX-072-24
|
Facility
OP
|
$3,458.00
|
|
| Hospital Charge Code |
5787648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$13,832.00 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| Rate for Payer: Aetna Managed Medicare |
$968.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,247.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,729.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,935.10
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,247.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,074.80
|
| Rate for Payer: The Alliance Commercial |
$13,832.00
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.34
|
|
|
DRILL BIT 2.4MM CLX CLX-072-24
|
Facility
IP
|
$3,458.00
|
|
| Hospital Charge Code |
5787648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,694.42 |
| Max. Negotiated Rate |
$3,181.36 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,074.80
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.34
|
|
|
DRILL BIT 2.4MM M.I.B. 317-24-001
|
Facility
IP
|
$2,585.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5506860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
DRILL BIT 2.4MM M.I.B. 317-24-001
|
Facility
OP
|
$2,585.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5506860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.80 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$723.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.57
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.75
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
DRILL BIT 2.4MM STD MID-FOOT MFT-072-24
|
Facility
IP
|
$3,458.00
|
|
| Hospital Charge Code |
4028661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,694.42 |
| Max. Negotiated Rate |
$3,181.36 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,074.80
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.34
|
|
|
DRILL BIT 2.4MM STD MID-FOOT MFT-072-24
|
Facility
OP
|
$3,458.00
|
|
| Hospital Charge Code |
4028661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$13,832.00 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| Rate for Payer: Aetna Managed Medicare |
$968.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,247.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,729.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,935.10
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,247.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,074.80
|
| Rate for Payer: The Alliance Commercial |
$13,832.00
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.34
|
|
|
DRILL BIT 2.4MM X 122MM AO COUPLING STRYKER 703696
|
Facility
IP
|
$2,794.00
|
|
| Hospital Charge Code |
5458926
|
|
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 2.4MM X 122MM AO COUPLING STRYKER 703696
|
Facility
OP
|
$2,794.00
|
|
| Hospital Charge Code |
5458926
|
|
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 2.4 X 100MM 310.530
|
Facility
IP
|
$2,318.00
|
|
| Hospital Charge Code |
2966184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,135.82 |
| Max. Negotiated Rate |
$2,132.56 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,390.80
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
DRILL BIT 2.4 X 100MM 310.530
|
Facility
OP
|
$2,318.00
|
|
| Hospital Charge Code |
2966184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.04 |
| Max. Negotiated Rate |
$9,272.00 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Aetna Managed Medicare |
$649.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,506.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,159.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.15
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,738.50
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,506.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,390.80
|
| Rate for Payer: The Alliance Commercial |
$9,272.00
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
DRILL BIT 2.4x186 QUICK COUPLE
|
Facility
IP
|
$2,856.00
|
|
| Hospital Charge Code |
2966185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.44 |
| Max. Negotiated Rate |
$2,627.52 |
| Rate for Payer: Aetna Commercial |
$2,570.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,513.68
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna Commercial |
$2,627.52
|
| Rate for Payer: Health EOS Commercial |
$2,541.84
|
| Rate for Payer: HFN Commercial |
$2,627.52
|
| Rate for Payer: Multiplan Commercial |
$2,284.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,713.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,627.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.44
|
| Rate for Payer: Quartz Commercial |
$1,713.60
|
| Rate for Payer: WEA Trust Commercial |
$1,570.80
|
| Rate for Payer: WPS Commercial |
$2,115.44
|
|
|
DRILL BIT 2.4x186 QUICK COUPLE
|
Facility
OP
|
$2,856.00
|
|
| Hospital Charge Code |
2966185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.68 |
| Max. Negotiated Rate |
$11,424.00 |
| Rate for Payer: Aetna Commercial |
$2,570.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.16
|
| Rate for Payer: Aetna Managed Medicare |
$799.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,856.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,428.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,370.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,513.68
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna Commercial |
$2,627.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,598.22
|
| Rate for Payer: Health EOS Commercial |
$2,541.84
|
| Rate for Payer: HFN Commercial |
$2,627.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,142.00
|
| Rate for Payer: Multiplan Commercial |
$2,284.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,713.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,627.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.44
|
| Rate for Payer: Quartz Commercial |
$1,856.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,713.60
|
| Rate for Payer: The Alliance Commercial |
$11,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,570.80
|
| Rate for Payer: WPS Commercial |
$2,115.44
|
|
|
DRILL BIT 2.5MM
|
Facility
IP
|
$2,747.00
|
|
| Hospital Charge Code |
3072633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,346.03 |
| Max. Negotiated Rate |
$2,527.24 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,648.20
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
DRILL BIT 2.5MM
|
Facility
OP
|
$2,747.00
|
|
| Hospital Charge Code |
3072633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.16 |
| Max. Negotiated Rate |
$10,988.00 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Aetna Managed Medicare |
$769.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.22
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.25
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,785.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.20
|
| Rate for Payer: The Alliance Commercial |
$10,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
DRILL BIT 2.5MM AR-8943-30
|
Facility
IP
|
$1,357.00
|
|
| Hospital Charge Code |
4594700
|
|
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 2.5MM AR-8943-30
|
Facility
OP
|
$1,357.00
|
|
| Hospital Charge Code |
4594700
|
|
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 2.5MM CALIBRATED 95MM 03.113.023
|
Facility
OP
|
$1,373.00
|
|
| Hospital Charge Code |
4268749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Aetna Managed Medicare |
$384.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.33
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.75
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$892.45
|
| Rate for Payer: Quartz Medicare Advantage |
$823.80
|
| Rate for Payer: The Alliance Commercial |
$5,492.00
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
DRILL BIT 2.5MM CALIBRATED 95MM 03.113.023
|
Facility
IP
|
$1,373.00
|
|
| Hospital Charge Code |
4268749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,263.16 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$823.80
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
DRILL BIT 2.5MM CALIBRATED AR-8916-06
|
Facility
OP
|
$1,086.00
|
|
| Hospital Charge Code |
5384974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Aetna Managed Medicare |
$304.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$543.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.73
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.50
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$705.90
|
| Rate for Payer: Quartz Medicare Advantage |
$651.60
|
| Rate for Payer: The Alliance Commercial |
$4,344.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
DRILL BIT 2.5MM CALIBRATED AR-8916-06
|
Facility
IP
|
$1,086.00
|
|
| Hospital Charge Code |
5384974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.14 |
| Max. Negotiated Rate |
$999.12 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$651.60
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
DRILL BIT 2.5MM CALIBRATED AR-8943-13
|
Facility
IP
|
$1,357.00
|
|
| Hospital Charge Code |
4317093
|
|
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 2.5MM CALIBRATED AR-8943-13
|
Facility
OP
|
$1,357.00
|
|
| Hospital Charge Code |
4317093
|
|
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 2.5MM CANNULATED DSDS0025
|
Facility
IP
|
$2,203.00
|
|
| Hospital Charge Code |
6177663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,079.47 |
| Max. Negotiated Rate |
$2,026.76 |
| Rate for Payer: Aetna Commercial |
$1,982.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.59
|
| Rate for Payer: Cash Price |
$660.90
|
| Rate for Payer: Cigna Commercial |
$2,026.76
|
| Rate for Payer: Health EOS Commercial |
$1,960.67
|
| Rate for Payer: HFN Commercial |
$2,026.76
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.47
|
| Rate for Payer: Quartz Commercial |
$1,321.80
|
| Rate for Payer: WEA Trust Commercial |
$1,211.65
|
| Rate for Payer: WPS Commercial |
$1,631.76
|
|
|
DRILL BIT 2.5MM CANNULATED DSDS0025
|
Facility
OP
|
$2,203.00
|
|
| Hospital Charge Code |
6177663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.84 |
| Max. Negotiated Rate |
$8,812.00 |
| Rate for Payer: Aetna Commercial |
$1,982.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.58
|
| Rate for Payer: Aetna Managed Medicare |
$616.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,057.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.59
|
| Rate for Payer: Cash Price |
$660.90
|
| Rate for Payer: Cigna Commercial |
$2,026.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.80
|
| Rate for Payer: Health EOS Commercial |
$1,960.67
|
| Rate for Payer: HFN Commercial |
$2,026.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,652.25
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.47
|
| Rate for Payer: Quartz Commercial |
$1,431.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.80
|
| Rate for Payer: The Alliance Commercial |
$8,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,211.65
|
| Rate for Payer: WPS Commercial |
$1,631.76
|
|
|
DRILL BIT 2.5MM GRADUATED & LASER MARKED AR-8943-42
|
Facility
OP
|
$1,357.00
|
|
| Hospital Charge Code |
5349252
|
|
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
|
|
