|
DRILL BIT 2.0 X 105MM
|
Facility
|
IP
|
$2,135.00
|
|
| Hospital Charge Code |
2964736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,046.15 |
| Max. Negotiated Rate |
$1,964.20 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,281.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
DRILL BIT 2.0 X 105MM
|
Facility
|
OP
|
$2,135.00
|
|
| Hospital Charge Code |
2964736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$8,540.00 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.10
|
| Rate for Payer: Aetna Managed Medicare |
$597.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,387.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,067.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,024.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,194.75
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,601.25
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,387.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,281.00
|
| Rate for Payer: The Alliance Commercial |
$8,540.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
DRILL BIT 2.0 X 140MM WITH DEPTH MARK 323.062
|
Facility
|
IP
|
$2,273.00
|
|
| Hospital Charge Code |
2966182
|
|
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 2.0 X 140MM WITH DEPTH MARK 323.062
|
Facility
|
OP
|
$2,273.00
|
|
| Hospital Charge Code |
2966182
|
|
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 2.0 X 140 QUICK COUPLE 03.133.101
|
Facility
|
OP
|
$2,151.00
|
|
| Hospital Charge Code |
6180414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$602.28 |
| Max. Negotiated Rate |
$8,604.00 |
| Rate for Payer: Aetna Commercial |
$1,935.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,849.86
|
| Rate for Payer: Aetna Managed Medicare |
$602.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,398.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,075.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,032.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,140.03
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cigna Commercial |
$1,978.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,203.70
|
| Rate for Payer: Health EOS Commercial |
$1,914.39
|
| Rate for Payer: HFN Commercial |
$1,978.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,613.25
|
| Rate for Payer: Multiplan Commercial |
$1,720.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,290.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,978.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.99
|
| Rate for Payer: Quartz Commercial |
$1,398.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,290.60
|
| Rate for Payer: The Alliance Commercial |
$8,604.00
|
| Rate for Payer: WEA Trust Commercial |
$1,183.05
|
| Rate for Payer: WPS Commercial |
$1,593.25
|
|
|
DRILL BIT 2.0 X 140 QUICK COUPLE 03.133.101
|
Facility
|
IP
|
$2,151.00
|
|
| Hospital Charge Code |
6180414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,053.99 |
| Max. Negotiated Rate |
$1,978.92 |
| Rate for Payer: Aetna Commercial |
$1,935.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,849.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,140.03
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cigna Commercial |
$1,978.92
|
| Rate for Payer: Health EOS Commercial |
$1,914.39
|
| Rate for Payer: HFN Commercial |
$1,978.92
|
| Rate for Payer: Multiplan Commercial |
$1,720.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,290.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,978.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.99
|
| Rate for Payer: Quartz Commercial |
$1,290.60
|
| Rate for Payer: WEA Trust Commercial |
$1,183.05
|
| Rate for Payer: WPS Commercial |
$1,593.25
|
|
|
DRILL BIT 2.0 X 150 CANN 310.221
|
Facility
|
OP
|
$4,976.00
|
|
| Hospital Charge Code |
2966179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,393.28 |
| Max. Negotiated Rate |
$19,904.00 |
| Rate for Payer: Aetna Commercial |
$4,478.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,279.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,234.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,488.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,388.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,637.28
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$4,577.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,784.57
|
| Rate for Payer: Health EOS Commercial |
$4,428.64
|
| Rate for Payer: HFN Commercial |
$4,577.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,732.00
|
| Rate for Payer: Multiplan Commercial |
$3,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,985.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,577.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.24
|
| Rate for Payer: Quartz Commercial |
$3,234.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,985.60
|
| Rate for Payer: The Alliance Commercial |
$19,904.00
|
| Rate for Payer: WEA Trust Commercial |
$2,736.80
|
| Rate for Payer: WPS Commercial |
$3,685.72
|
|
|
DRILL BIT 2.0 X 150 CANN 310.221
|
Facility
|
IP
|
$4,976.00
|
|
| Hospital Charge Code |
2966179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,438.24 |
| Max. Negotiated Rate |
$4,577.92 |
| Rate for Payer: Aetna Commercial |
$4,478.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,279.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,637.28
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$4,577.92
|
| Rate for Payer: Health EOS Commercial |
$4,428.64
|
| Rate for Payer: HFN Commercial |
$4,577.92
|
| Rate for Payer: Multiplan Commercial |
$3,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,985.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,577.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.24
|
| Rate for Payer: Quartz Commercial |
$2,985.60
|
| Rate for Payer: WEA Trust Commercial |
$2,736.80
|
| Rate for Payer: WPS Commercial |
$3,685.72
|
|
|
DRILL BIT 2.0 X 150MM ASNIS III 702453
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
6182540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.25 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$795.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
DRILL BIT 2.0 X 150MM ASNIS III 702453
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
6182540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.50
|
| Rate for Payer: Aetna Managed Medicare |
$371.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.75
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$861.25
|
| Rate for Payer: Quartz Medicare Advantage |
$795.00
|
| Rate for Payer: The Alliance Commercial |
$5,300.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
DRILL BIT 2.0 X 30MM ORTHOLOC 58880020
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5415912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.28 |
| Max. Negotiated Rate |
$9,004.00 |
| Rate for Payer: Aetna Commercial |
$2,025.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.86
|
| Rate for Payer: Aetna Managed Medicare |
$630.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,463.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,125.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,080.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,193.03
|
| Rate for Payer: Cash Price |
$675.30
|
| Rate for Payer: Cigna Commercial |
$2,070.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,259.66
|
| Rate for Payer: Health EOS Commercial |
$2,003.39
|
| Rate for Payer: HFN Commercial |
$2,070.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,688.25
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.99
|
| Rate for Payer: Quartz Commercial |
$1,463.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.60
|
| Rate for Payer: The Alliance Commercial |
$9,004.00
|
| Rate for Payer: WEA Trust Commercial |
$1,238.05
|
| Rate for Payer: WPS Commercial |
$1,667.32
|
|
|
DRILL BIT 2.0 X 30MM ORTHOLOC 58880020
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5415912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.99 |
| Max. Negotiated Rate |
$2,070.92 |
| Rate for Payer: Aetna Commercial |
$2,025.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,193.03
|
| Rate for Payer: Cash Price |
$675.30
|
| Rate for Payer: Cigna Commercial |
$2,070.92
|
| Rate for Payer: Health EOS Commercial |
$2,003.39
|
| Rate for Payer: HFN Commercial |
$2,070.92
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.99
|
| Rate for Payer: Quartz Commercial |
$1,350.60
|
| Rate for Payer: WEA Trust Commercial |
$1,238.05
|
| Rate for Payer: WPS Commercial |
$1,667.32
|
|
|
DRILL BIT 2.0 X 60MM ORTHOLOC 58850020
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5729842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.99 |
| Max. Negotiated Rate |
$2,070.92 |
| Rate for Payer: Aetna Commercial |
$2,025.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,193.03
|
| Rate for Payer: Cash Price |
$675.30
|
| Rate for Payer: Cigna Commercial |
$2,070.92
|
| Rate for Payer: Health EOS Commercial |
$2,003.39
|
| Rate for Payer: HFN Commercial |
$2,070.92
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.99
|
| Rate for Payer: Quartz Commercial |
$1,350.60
|
| Rate for Payer: WEA Trust Commercial |
$1,238.05
|
| Rate for Payer: WPS Commercial |
$1,667.32
|
|
|
DRILL BIT 2.0 X 60MM ORTHOLOC 58850020
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5729842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.28 |
| Max. Negotiated Rate |
$9,004.00 |
| Rate for Payer: Aetna Commercial |
$2,025.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.86
|
| Rate for Payer: Aetna Managed Medicare |
$630.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,463.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,125.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,080.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,193.03
|
| Rate for Payer: Cash Price |
$675.30
|
| Rate for Payer: Cigna Commercial |
$2,070.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,259.66
|
| Rate for Payer: Health EOS Commercial |
$2,003.39
|
| Rate for Payer: HFN Commercial |
$2,070.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,688.25
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.99
|
| Rate for Payer: Quartz Commercial |
$1,463.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.60
|
| Rate for Payer: The Alliance Commercial |
$9,004.00
|
| Rate for Payer: WEA Trust Commercial |
$1,238.05
|
| Rate for Payer: WPS Commercial |
$1,667.32
|
|
|
DRILL BIT 2.0 X 65MM MINI QUICK COUPLER 310.201
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
2966183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$671.30 |
| Max. Negotiated Rate |
$1,260.40 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,178.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.10
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,260.40
|
| Rate for Payer: Health EOS Commercial |
$1,219.30
|
| Rate for Payer: HFN Commercial |
$1,260.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$822.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.40
|
| Rate for Payer: Quartz Beloit One Network |
$671.30
|
| Rate for Payer: Quartz Commercial |
$822.00
|
| Rate for Payer: WEA Trust Commercial |
$753.50
|
| Rate for Payer: WPS Commercial |
$1,014.76
|
|
|
DRILL BIT 2.0 X 65MM MINI QUICK COUPLER 310.201
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
2966183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$5,480.00 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,178.20
|
| Rate for Payer: Aetna Managed Medicare |
$383.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$890.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$685.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$657.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.10
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,260.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$766.65
|
| Rate for Payer: Health EOS Commercial |
$1,219.30
|
| Rate for Payer: HFN Commercial |
$1,260.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,027.50
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$822.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.40
|
| Rate for Payer: Quartz Beloit One Network |
$671.30
|
| Rate for Payer: Quartz Commercial |
$890.50
|
| Rate for Payer: Quartz Medicare Advantage |
$822.00
|
| Rate for Payer: The Alliance Commercial |
$5,480.00
|
| Rate for Payer: WEA Trust Commercial |
$753.50
|
| Rate for Payer: WPS Commercial |
$1,014.76
|
|
|
DRILL BIT 2.0 X 85MM JACOBS CHUCK 310.20
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
5563412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$3,740.00 |
| Rate for Payer: Aetna Commercial |
$841.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.10
|
| Rate for Payer: Aetna Managed Medicare |
$261.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$607.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$467.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$448.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.55
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.23
|
| Rate for Payer: Health EOS Commercial |
$832.15
|
| Rate for Payer: HFN Commercial |
$860.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.25
|
| Rate for Payer: Multiplan Commercial |
$748.00
|
| Rate for Payer: NAPHCARE Commercial |
$561.00
|
| Rate for Payer: Preferred Network Access Commercial |
$860.20
|
| Rate for Payer: Quartz Beloit One Network |
$458.15
|
| Rate for Payer: Quartz Commercial |
$607.75
|
| Rate for Payer: Quartz Medicare Advantage |
$561.00
|
| Rate for Payer: The Alliance Commercial |
$3,740.00
|
| Rate for Payer: WEA Trust Commercial |
$514.25
|
| Rate for Payer: WPS Commercial |
$692.55
|
|
|
DRILL BIT 2.0 X 85MM JACOBS CHUCK 310.20
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
5563412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.15 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Aetna Commercial |
$841.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.55
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: Health EOS Commercial |
$832.15
|
| Rate for Payer: HFN Commercial |
$860.20
|
| Rate for Payer: Multiplan Commercial |
$748.00
|
| Rate for Payer: NAPHCARE Commercial |
$561.00
|
| Rate for Payer: Preferred Network Access Commercial |
$860.20
|
| Rate for Payer: Quartz Beloit One Network |
$458.15
|
| Rate for Payer: Quartz Commercial |
$561.00
|
| Rate for Payer: WEA Trust Commercial |
$514.25
|
| Rate for Payer: WPS Commercial |
$692.55
|
|
|
DRILL BIT 2.2MM CANNULATED DSDS0022
|
Facility
|
OP
|
$2,602.00
|
|
| Hospital Charge Code |
6165647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.56 |
| Max. Negotiated Rate |
$10,408.00 |
| Rate for Payer: Aetna Commercial |
$2,341.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,237.72
|
| Rate for Payer: Aetna Managed Medicare |
$728.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,691.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,248.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.06
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$2,393.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,456.08
|
| Rate for Payer: Health EOS Commercial |
$2,315.78
|
| Rate for Payer: HFN Commercial |
$2,393.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,951.50
|
| Rate for Payer: Multiplan Commercial |
$2,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,393.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.98
|
| Rate for Payer: Quartz Commercial |
$1,691.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,561.20
|
| Rate for Payer: The Alliance Commercial |
$10,408.00
|
| Rate for Payer: WEA Trust Commercial |
$1,431.10
|
| Rate for Payer: WPS Commercial |
$1,927.30
|
|
|
DRILL BIT 2.2MM CANNULATED DSDS0022
|
Facility
|
IP
|
$2,602.00
|
|
| Hospital Charge Code |
6165647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,274.98 |
| Max. Negotiated Rate |
$2,393.84 |
| Rate for Payer: Aetna Commercial |
$2,341.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,237.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.06
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$2,393.84
|
| Rate for Payer: Health EOS Commercial |
$2,315.78
|
| Rate for Payer: HFN Commercial |
$2,393.84
|
| Rate for Payer: Multiplan Commercial |
$2,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,393.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.98
|
| Rate for Payer: Quartz Commercial |
$1,561.20
|
| Rate for Payer: WEA Trust Commercial |
$1,431.10
|
| Rate for Payer: WPS Commercial |
$1,927.30
|
|
|
DRILL BIT 2.3MM ACUMED QUICK COUPLING 80-0627
|
Facility
|
IP
|
$2,266.00
|
|
| Hospital Charge Code |
5547305
|
|
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 2.3MM ACUMED QUICK COUPLING 80-0627
|
Facility
|
OP
|
$2,266.00
|
|
| Hospital Charge Code |
5547305
|
|
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 2.4MM 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: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| 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
|
|
