|
DRILL BIT 1.5MM X 83MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.301
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861728
|
|
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 1.5MM X 83MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.301
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861728
|
|
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 1.5MM X 85MM QUICK COUPLE 310.15
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
5074874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
DRILL BIT 1.5MM X 85MM QUICK COUPLE 310.15
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
5074874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
DRILL BIT 1.5 X 96MM MINI QUICK COUPLER DEPTH MARKER 310.507
|
Facility
|
IP
|
$2,349.00
|
|
| Hospital Charge Code |
2966175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,151.01 |
| Max. Negotiated Rate |
$2,161.08 |
| Rate for Payer: Aetna Commercial |
$2,114.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,020.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.97
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,161.08
|
| Rate for Payer: Health EOS Commercial |
$2,090.61
|
| Rate for Payer: HFN Commercial |
$2,161.08
|
| Rate for Payer: Multiplan Commercial |
$1,879.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,409.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,161.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,151.01
|
| Rate for Payer: Quartz Commercial |
$1,409.40
|
| Rate for Payer: WEA Trust Commercial |
$1,291.95
|
| Rate for Payer: WPS Commercial |
$1,739.90
|
|
|
DRILL BIT 1.5 X 96MM MINI QUICK COUPLER DEPTH MARKER 310.507
|
Facility
|
OP
|
$2,349.00
|
|
| Hospital Charge Code |
2966175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$657.72 |
| Max. Negotiated Rate |
$9,396.00 |
| Rate for Payer: Aetna Commercial |
$2,114.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,020.14
|
| Rate for Payer: Aetna Managed Medicare |
$657.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,526.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,127.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.97
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,161.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,314.50
|
| Rate for Payer: Health EOS Commercial |
$2,090.61
|
| Rate for Payer: HFN Commercial |
$2,161.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,761.75
|
| Rate for Payer: Multiplan Commercial |
$1,879.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,409.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,161.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,151.01
|
| Rate for Payer: Quartz Commercial |
$1,526.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,409.40
|
| Rate for Payer: The Alliance Commercial |
$9,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,291.95
|
| Rate for Payer: WPS Commercial |
$1,739.90
|
|
|
DRILL BIT 1.6MM 52031630
|
Facility
|
OP
|
$2,582.00
|
|
| Hospital Charge Code |
6149647
|
|
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 1.6MM 52031630
|
Facility
|
IP
|
$2,582.00
|
|
| Hospital Charge Code |
6149647
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,220.52
|
| 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 16MM CANN FLEXIBLE 03.037.002
|
Facility
|
OP
|
$6,424.00
|
|
| Hospital Charge Code |
5178627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,798.72 |
| Max. Negotiated Rate |
$25,696.00 |
| Rate for Payer: Aetna Commercial |
$5,781.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,524.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,798.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,175.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,212.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,083.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,404.72
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna Commercial |
$5,910.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,594.87
|
| Rate for Payer: Health EOS Commercial |
$5,717.36
|
| Rate for Payer: HFN Commercial |
$5,910.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,818.00
|
| Rate for Payer: Multiplan Commercial |
$5,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,910.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,147.76
|
| Rate for Payer: Quartz Commercial |
$4,175.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,854.40
|
| Rate for Payer: The Alliance Commercial |
$25,696.00
|
| Rate for Payer: WEA Trust Commercial |
$3,533.20
|
| Rate for Payer: WPS Commercial |
$4,758.26
|
|
|
DRILL BIT 16MM CANN FLEXIBLE 03.037.002
|
Facility
|
IP
|
$6,424.00
|
|
| Hospital Charge Code |
5178627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,147.76 |
| Max. Negotiated Rate |
$5,910.08 |
| Rate for Payer: Aetna Commercial |
$5,781.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,524.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,404.72
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna Commercial |
$5,910.08
|
| Rate for Payer: Health EOS Commercial |
$5,717.36
|
| Rate for Payer: HFN Commercial |
$5,910.08
|
| Rate for Payer: Multiplan Commercial |
$5,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,910.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,147.76
|
| Rate for Payer: Quartz Commercial |
$3,854.40
|
| Rate for Payer: WEA Trust Commercial |
$3,533.20
|
| Rate for Payer: WPS Commercial |
$4,758.26
|
|
|
DRILL BIT 1.7MM LONG AR-8916-14
|
Facility
|
OP
|
$1,263.00
|
|
| Hospital Charge Code |
5200629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.64 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Aetna Commercial |
$1,136.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,086.18
|
| Rate for Payer: Aetna Managed Medicare |
$353.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$820.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$631.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$606.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.39
|
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Cigna Commercial |
$1,161.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.77
|
| Rate for Payer: Health EOS Commercial |
$1,124.07
|
| Rate for Payer: HFN Commercial |
$1,161.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$947.25
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: NAPHCARE Commercial |
$757.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.96
|
| Rate for Payer: Quartz Beloit One Network |
$618.87
|
| Rate for Payer: Quartz Commercial |
$820.95
|
| Rate for Payer: Quartz Medicare Advantage |
$757.80
|
| Rate for Payer: The Alliance Commercial |
$5,052.00
|
| Rate for Payer: WEA Trust Commercial |
$694.65
|
| Rate for Payer: WPS Commercial |
$935.50
|
|
|
DRILL BIT 1.7MM LONG AR-8916-14
|
Facility
|
IP
|
$1,263.00
|
|
| Hospital Charge Code |
5200629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.87 |
| Max. Negotiated Rate |
$1,161.96 |
| Rate for Payer: Aetna Commercial |
$1,136.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,086.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.39
|
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Cigna Commercial |
$1,161.96
|
| Rate for Payer: Health EOS Commercial |
$1,124.07
|
| Rate for Payer: HFN Commercial |
$1,161.96
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: NAPHCARE Commercial |
$757.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.96
|
| Rate for Payer: Quartz Beloit One Network |
$618.87
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: WEA Trust Commercial |
$694.65
|
| Rate for Payer: WPS Commercial |
$935.50
|
|
|
DRILL BIT 1.7MM SHORT AR-8916-28
|
Facility
|
IP
|
$1,167.00
|
|
| Hospital Charge Code |
6166573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.83 |
| Max. Negotiated Rate |
$1,073.64 |
| Rate for Payer: Aetna Commercial |
$1,050.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,003.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$618.51
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna Commercial |
$1,073.64
|
| Rate for Payer: Health EOS Commercial |
$1,038.63
|
| Rate for Payer: HFN Commercial |
$1,073.64
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: NAPHCARE Commercial |
$700.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,073.64
|
| Rate for Payer: Quartz Beloit One Network |
$571.83
|
| Rate for Payer: Quartz Commercial |
$700.20
|
| Rate for Payer: WEA Trust Commercial |
$641.85
|
| Rate for Payer: WPS Commercial |
$864.40
|
|
|
DRILL BIT 1.7MM SHORT AR-8916-28
|
Facility
|
OP
|
$1,167.00
|
|
| Hospital Charge Code |
6166573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.76 |
| Max. Negotiated Rate |
$4,668.00 |
| Rate for Payer: Aetna Commercial |
$1,050.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,003.62
|
| Rate for Payer: Aetna Managed Medicare |
$326.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$758.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$583.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$560.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$618.51
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna Commercial |
$1,073.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$653.05
|
| Rate for Payer: Health EOS Commercial |
$1,038.63
|
| Rate for Payer: HFN Commercial |
$1,073.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$875.25
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: NAPHCARE Commercial |
$700.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,073.64
|
| Rate for Payer: Quartz Beloit One Network |
$571.83
|
| Rate for Payer: Quartz Commercial |
$758.55
|
| Rate for Payer: Quartz Medicare Advantage |
$700.20
|
| Rate for Payer: The Alliance Commercial |
$4,668.00
|
| Rate for Payer: WEA Trust Commercial |
$641.85
|
| Rate for Payer: WPS Commercial |
$864.40
|
|
|
DRILL BIT 1.8MM QUICK COUPLER 310.510
|
Facility
|
IP
|
$2,615.00
|
|
| Hospital Charge Code |
2966178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,281.35 |
| Max. Negotiated Rate |
$2,405.80 |
| Rate for Payer: Aetna Commercial |
$2,353.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.95
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,405.80
|
| Rate for Payer: Health EOS Commercial |
$2,327.35
|
| Rate for Payer: HFN Commercial |
$2,405.80
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.35
|
| Rate for Payer: Quartz Commercial |
$1,569.00
|
| Rate for Payer: WEA Trust Commercial |
$1,438.25
|
| Rate for Payer: WPS Commercial |
$1,936.93
|
|
|
DRILL BIT 1.8MM QUICK COUPLER 310.510
|
Facility
|
OP
|
$2,615.00
|
|
| Hospital Charge Code |
2966178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.20 |
| Max. Negotiated Rate |
$10,460.00 |
| Rate for Payer: Aetna Commercial |
$2,353.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.90
|
| Rate for Payer: Aetna Managed Medicare |
$732.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,699.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.95
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,405.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.35
|
| Rate for Payer: Health EOS Commercial |
$2,327.35
|
| Rate for Payer: HFN Commercial |
$2,405.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,961.25
|
| Rate for Payer: Multiplan Commercial |
$2,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.35
|
| Rate for Payer: Quartz Commercial |
$1,699.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,569.00
|
| Rate for Payer: The Alliance Commercial |
$10,460.00
|
| Rate for Payer: WEA Trust Commercial |
$1,438.25
|
| Rate for Payer: WPS Commercial |
$1,936.93
|
|
|
DRILL BIT 1.8 X 110MM WITH DEPTH MARK 310.509
|
Facility
|
IP
|
$2,273.00
|
|
| Hospital Charge Code |
2966177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,113.77 |
| Max. Negotiated Rate |
$2,091.16 |
| Rate for Payer: Aetna Commercial |
$2,045.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,954.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,204.69
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cigna Commercial |
$2,091.16
|
| Rate for Payer: Health EOS Commercial |
$2,022.97
|
| Rate for Payer: HFN Commercial |
$2,091.16
|
| Rate for Payer: Multiplan Commercial |
$1,818.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,363.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.77
|
| Rate for Payer: Quartz Commercial |
$1,363.80
|
| Rate for Payer: WEA Trust Commercial |
$1,250.15
|
| Rate for Payer: WPS Commercial |
$1,683.61
|
|
|
DRILL BIT 1.8 X 110MM WITH DEPTH MARK 310.509
|
Facility
|
OP
|
$2,273.00
|
|
| Hospital Charge Code |
2966177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.44 |
| Max. Negotiated Rate |
$9,092.00 |
| Rate for Payer: Aetna Commercial |
$2,045.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,954.78
|
| Rate for Payer: Aetna Managed Medicare |
$636.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,477.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,136.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,091.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,204.69
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cigna Commercial |
$2,091.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,271.97
|
| Rate for Payer: Health EOS Commercial |
$2,022.97
|
| Rate for Payer: HFN Commercial |
$2,091.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,704.75
|
| Rate for Payer: Multiplan Commercial |
$1,818.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,363.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.77
|
| Rate for Payer: Quartz Commercial |
$1,477.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,363.80
|
| Rate for Payer: The Alliance Commercial |
$9,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,250.15
|
| Rate for Payer: WPS Commercial |
$1,683.61
|
|
|
DRILL BIT 1.9MM X 27MM 60-19326
|
Facility
|
IP
|
$989.00
|
|
| Hospital Charge Code |
3983365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.61 |
| Max. Negotiated Rate |
$909.88 |
| Rate for Payer: Aetna Commercial |
$890.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.54
|
| 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 1.9MM X 27MM 60-19326
|
Facility
|
OP
|
$989.00
|
|
| Hospital Charge Code |
3983365
|
|
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 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 2.0/2.4 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: Aetna Gatekeeper/Not Gatekeeper |
$2,491.42
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,948.76
|
| 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 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 (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
|
|
