|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,288.28
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,049.20
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,198.84
|
| 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 1.0MM (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 1.0MMX50MM 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 1.0MMX50MM 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: Aetna Gatekeeper/Not Gatekeeper |
$767.98
|
| 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 1.0MM 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: Aetna Gatekeeper/Not Gatekeeper |
$1,154.98
|
| 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 1.0MM 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 |
$5,372.00 |
| 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: The Alliance Commercial |
$5,372.00
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$5,099.80
|
| 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 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,754.40
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$751.64
|
| 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 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 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 |
$5,372.00 |
| 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: The Alliance Commercial |
$5,372.00
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,154.98
|
| 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 1.1x5.0 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: Aetna Gatekeeper/Not Gatekeeper |
$1,784.50
|
| 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
|
|
