|
DRILL SLEEVE 2.8MM 323.054
|
Facility
IP
|
$2,165.00
|
|
| Hospital Charge Code |
2966608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.85 |
| Max. Negotiated Rate |
$1,991.80 |
| Rate for Payer: Aetna Commercial |
$1,948.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.45
|
| Rate for Payer: Cash Price |
$649.50
|
| Rate for Payer: Cigna Commercial |
$1,991.80
|
| Rate for Payer: Health EOS Commercial |
$1,926.85
|
| Rate for Payer: HFN Commercial |
$1,991.80
|
| Rate for Payer: Multiplan Commercial |
$1,732.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,299.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.85
|
| Rate for Payer: Quartz Commercial |
$1,299.00
|
| Rate for Payer: WEA Trust Commercial |
$1,190.75
|
| Rate for Payer: WPS Commercial |
$1,603.62
|
|
|
DRILL SLEEVE 2.8MM 323.054
|
Facility
OP
|
$2,165.00
|
|
| Hospital Charge Code |
2966608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.20 |
| Max. Negotiated Rate |
$8,660.00 |
| Rate for Payer: Aetna Commercial |
$1,948.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.90
|
| Rate for Payer: Aetna Managed Medicare |
$606.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,407.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,082.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,039.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.45
|
| Rate for Payer: Cash Price |
$649.50
|
| Rate for Payer: Cigna Commercial |
$1,991.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,211.53
|
| Rate for Payer: Health EOS Commercial |
$1,926.85
|
| Rate for Payer: HFN Commercial |
$1,991.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,623.75
|
| Rate for Payer: Multiplan Commercial |
$1,732.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,299.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.85
|
| Rate for Payer: Quartz Commercial |
$1,407.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,299.00
|
| Rate for Payer: The Alliance Commercial |
$8,660.00
|
| Rate for Payer: WEA Trust Commercial |
$1,190.75
|
| Rate for Payer: WPS Commercial |
$1,603.62
|
|
|
DRILL SLEEVE 3.5 FLIPCUTTER
|
Facility
IP
|
$3,019.00
|
|
| Hospital Charge Code |
2964680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,479.31 |
| Max. Negotiated Rate |
$2,777.48 |
| Rate for Payer: Aetna Commercial |
$2,717.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.07
|
| Rate for Payer: Cash Price |
$905.70
|
| Rate for Payer: Cigna Commercial |
$2,777.48
|
| Rate for Payer: Health EOS Commercial |
$2,686.91
|
| Rate for Payer: HFN Commercial |
$2,777.48
|
| Rate for Payer: Multiplan Commercial |
$2,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,811.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,777.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.31
|
| Rate for Payer: Quartz Commercial |
$1,811.40
|
| Rate for Payer: WEA Trust Commercial |
$1,660.45
|
| Rate for Payer: WPS Commercial |
$2,236.17
|
|
|
DRILL SLEEVE 3.5 FLIPCUTTER
|
Facility
OP
|
$3,019.00
|
|
| Hospital Charge Code |
2964680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.32 |
| Max. Negotiated Rate |
$12,076.00 |
| Rate for Payer: Aetna Commercial |
$2,717.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,596.34
|
| Rate for Payer: Aetna Managed Medicare |
$845.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,962.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,449.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.07
|
| Rate for Payer: Cash Price |
$905.70
|
| Rate for Payer: Cigna Commercial |
$2,777.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,689.43
|
| Rate for Payer: Health EOS Commercial |
$2,686.91
|
| Rate for Payer: HFN Commercial |
$2,777.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,264.25
|
| Rate for Payer: Multiplan Commercial |
$2,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,811.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,777.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.31
|
| Rate for Payer: Quartz Commercial |
$1,962.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,811.40
|
| Rate for Payer: The Alliance Commercial |
$12,076.00
|
| Rate for Payer: WEA Trust Commercial |
$1,660.45
|
| Rate for Payer: WPS Commercial |
$2,236.17
|
|
|
DRILL SPEEDGUIDE 2.0MM X 30MM 703891
|
Facility
OP
|
$1,462.00
|
|
| Hospital Charge Code |
6172081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.36 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.32
|
| Rate for Payer: Aetna Managed Medicare |
$409.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$950.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$818.14
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,096.50
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$950.30
|
| Rate for Payer: Quartz Medicare Advantage |
$877.20
|
| Rate for Payer: The Alliance Commercial |
$5,848.00
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
DRILL SPEEDGUIDE 2.0MM X 30MM 703891
|
Facility
IP
|
$1,462.00
|
|
| Hospital Charge Code |
6172081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.38 |
| Max. Negotiated Rate |
$1,345.04 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$877.20
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
DRILL SPEEDGUIDE 2.6MM X 30MM 703894
|
Facility
IP
|
$1,388.00
|
|
| Hospital Charge Code |
6049674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.12 |
| Max. Negotiated Rate |
$1,276.96 |
| Rate for Payer: Aetna Commercial |
$1,249.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.64
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$1,276.96
|
| Rate for Payer: Health EOS Commercial |
$1,235.32
|
| Rate for Payer: HFN Commercial |
$1,276.96
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$832.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.96
|
| Rate for Payer: Quartz Beloit One Network |
$680.12
|
| Rate for Payer: Quartz Commercial |
$832.80
|
| Rate for Payer: WEA Trust Commercial |
$763.40
|
| Rate for Payer: WPS Commercial |
$1,028.09
|
|
|
DRILL SPEEDGUIDE 2.6MM X 30MM 703894
|
Facility
OP
|
$1,388.00
|
|
| Hospital Charge Code |
6049674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.64 |
| Max. Negotiated Rate |
$5,552.00 |
| Rate for Payer: Aetna Commercial |
$1,249.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.68
|
| Rate for Payer: Aetna Managed Medicare |
$388.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$902.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$666.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.64
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$1,276.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$776.72
|
| Rate for Payer: Health EOS Commercial |
$1,235.32
|
| Rate for Payer: HFN Commercial |
$1,276.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,041.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$832.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.96
|
| Rate for Payer: Quartz Beloit One Network |
$680.12
|
| Rate for Payer: Quartz Commercial |
$902.20
|
| Rate for Payer: Quartz Medicare Advantage |
$832.80
|
| Rate for Payer: The Alliance Commercial |
$5,552.00
|
| Rate for Payer: WEA Trust Commercial |
$763.40
|
| Rate for Payer: WPS Commercial |
$1,028.09
|
|
|
DRILL SPEEDGUIDE 3.0MM 70-3933
|
Facility
IP
|
$2,557.00
|
|
| Hospital Charge Code |
3791363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,252.93 |
| Max. Negotiated Rate |
$2,352.44 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,534.20
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
DRILL SPEEDGUIDE 3.0MM 70-3933
|
Facility
OP
|
$2,557.00
|
|
| Hospital Charge Code |
3791363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.96 |
| Max. Negotiated Rate |
$10,228.00 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Aetna Managed Medicare |
$715.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,662.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.90
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,662.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,534.20
|
| Rate for Payer: The Alliance Commercial |
$10,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
DRILL STOP SMART TOE 2.0
|
Facility
OP
|
$1,742.00
|
|
| Hospital Charge Code |
3072481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$6,968.00 |
| Rate for Payer: Aetna Commercial |
$1,567.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,498.12
|
| Rate for Payer: Aetna Managed Medicare |
$487.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,132.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$836.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.26
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$1,602.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$974.82
|
| Rate for Payer: Health EOS Commercial |
$1,550.38
|
| Rate for Payer: HFN Commercial |
$1,602.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,306.50
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,602.64
|
| Rate for Payer: Quartz Beloit One Network |
$853.58
|
| Rate for Payer: Quartz Commercial |
$1,132.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,045.20
|
| Rate for Payer: The Alliance Commercial |
$6,968.00
|
| Rate for Payer: WEA Trust Commercial |
$958.10
|
| Rate for Payer: WPS Commercial |
$1,290.30
|
|
|
DRILL STOP SMART TOE 2.0
|
Facility
IP
|
$1,742.00
|
|
| Hospital Charge Code |
3072481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$853.58 |
| Max. Negotiated Rate |
$1,602.64 |
| Rate for Payer: Aetna Commercial |
$1,567.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.26
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$1,602.64
|
| Rate for Payer: Health EOS Commercial |
$1,550.38
|
| Rate for Payer: HFN Commercial |
$1,602.64
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,602.64
|
| Rate for Payer: Quartz Beloit One Network |
$853.58
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: WEA Trust Commercial |
$958.10
|
| Rate for Payer: WPS Commercial |
$1,290.30
|
|
|
DRILL TH CANNULATED RELIEF #AI-4030
|
Facility
IP
|
$2,670.00
|
|
| Hospital Charge Code |
2964743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,308.30 |
| Max. Negotiated Rate |
$2,456.40 |
| Rate for Payer: Aetna Commercial |
$2,403.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.10
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,456.40
|
| Rate for Payer: Health EOS Commercial |
$2,376.30
|
| Rate for Payer: HFN Commercial |
$2,456.40
|
| Rate for Payer: Multiplan Commercial |
$2,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,456.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.30
|
| Rate for Payer: Quartz Commercial |
$1,602.00
|
| Rate for Payer: WEA Trust Commercial |
$1,468.50
|
| Rate for Payer: WPS Commercial |
$1,977.67
|
|
|
DRILL TH CANNULATED RELIEF #AI-4030
|
Facility
OP
|
$2,670.00
|
|
| Hospital Charge Code |
2964743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$10,680.00 |
| Rate for Payer: Aetna Commercial |
$2,403.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,296.20
|
| Rate for Payer: Aetna Managed Medicare |
$747.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,735.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,335.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,281.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.10
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,456.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,494.13
|
| Rate for Payer: Health EOS Commercial |
$2,376.30
|
| Rate for Payer: HFN Commercial |
$2,456.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,002.50
|
| Rate for Payer: Multiplan Commercial |
$2,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,456.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.30
|
| Rate for Payer: Quartz Commercial |
$1,735.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.00
|
| Rate for Payer: The Alliance Commercial |
$10,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,468.50
|
| Rate for Payer: WPS Commercial |
$1,977.67
|
|
|
DRILL TIP GUIDE WIRE 2.5 X 300 03.120.026
|
Facility
IP
|
$1,187.00
|
|
| Hospital Charge Code |
2966226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.63 |
| Max. Negotiated Rate |
$1,092.04 |
| Rate for Payer: Aetna Commercial |
$1,068.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.11
|
| Rate for Payer: Cash Price |
$356.10
|
| Rate for Payer: Cigna Commercial |
$1,092.04
|
| Rate for Payer: Health EOS Commercial |
$1,056.43
|
| Rate for Payer: HFN Commercial |
$1,092.04
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: NAPHCARE Commercial |
$712.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.04
|
| Rate for Payer: Quartz Beloit One Network |
$581.63
|
| Rate for Payer: Quartz Commercial |
$712.20
|
| Rate for Payer: WEA Trust Commercial |
$652.85
|
| Rate for Payer: WPS Commercial |
$879.21
|
|
|
DRILL TIP GUIDE WIRE 2.5 X 300 03.120.026
|
Facility
OP
|
$1,187.00
|
|
| Hospital Charge Code |
2966226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.36 |
| Max. Negotiated Rate |
$4,748.00 |
| Rate for Payer: Aetna Commercial |
$1,068.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.82
|
| Rate for Payer: Aetna Managed Medicare |
$332.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$771.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$593.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$569.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.11
|
| Rate for Payer: Cash Price |
$356.10
|
| Rate for Payer: Cigna Commercial |
$1,092.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.25
|
| Rate for Payer: Health EOS Commercial |
$1,056.43
|
| Rate for Payer: HFN Commercial |
$1,092.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$890.25
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: NAPHCARE Commercial |
$712.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.04
|
| Rate for Payer: Quartz Beloit One Network |
$581.63
|
| Rate for Payer: Quartz Commercial |
$771.55
|
| Rate for Payer: Quartz Medicare Advantage |
$712.20
|
| Rate for Payer: The Alliance Commercial |
$4,748.00
|
| Rate for Payer: WEA Trust Commercial |
$652.85
|
| Rate for Payer: WPS Commercial |
$879.21
|
|
|
DRILL TWIST CORTICAL OPENER 3.5MM 700353
|
Facility
IP
|
$1,402.00
|
|
| Hospital Charge Code |
3983346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.98 |
| Max. Negotiated Rate |
$1,289.84 |
| Rate for Payer: Aetna Commercial |
$1,261.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.06
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$1,289.84
|
| Rate for Payer: Health EOS Commercial |
$1,247.78
|
| Rate for Payer: HFN Commercial |
$1,289.84
|
| Rate for Payer: Multiplan Commercial |
$1,121.60
|
| Rate for Payer: NAPHCARE Commercial |
$841.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.84
|
| Rate for Payer: Quartz Beloit One Network |
$686.98
|
| Rate for Payer: Quartz Commercial |
$841.20
|
| Rate for Payer: WEA Trust Commercial |
$771.10
|
| Rate for Payer: WPS Commercial |
$1,038.46
|
|
|
DRILL TWIST CORTICAL OPENER 3.5MM 700353
|
Facility
OP
|
$1,402.00
|
|
| Hospital Charge Code |
3983346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.56 |
| Max. Negotiated Rate |
$5,608.00 |
| Rate for Payer: Aetna Commercial |
$1,261.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,205.72
|
| Rate for Payer: Aetna Managed Medicare |
$392.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$911.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$701.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.06
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$1,289.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.56
|
| Rate for Payer: Health EOS Commercial |
$1,247.78
|
| Rate for Payer: HFN Commercial |
$1,289.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,051.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.60
|
| Rate for Payer: NAPHCARE Commercial |
$841.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.84
|
| Rate for Payer: Quartz Beloit One Network |
$686.98
|
| Rate for Payer: Quartz Commercial |
$911.30
|
| Rate for Payer: Quartz Medicare Advantage |
$841.20
|
| Rate for Payer: The Alliance Commercial |
$5,608.00
|
| Rate for Payer: WEA Trust Commercial |
$771.10
|
| Rate for Payer: WPS Commercial |
$1,038.46
|
|
|
DRIVER 2.6MM SPADE 214-00-016
|
Facility
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5496695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Aetna Managed Medicare |
$744.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.54
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.00
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,729.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.00
|
| Rate for Payer: The Alliance Commercial |
$10,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRIVER 2.6MM SPADE 214-00-016
|
Facility
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5496695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRIVER 3.4MM SPADE 214-00-009
|
Facility
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5248638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Aetna Managed Medicare |
$744.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.54
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.00
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,729.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.00
|
| Rate for Payer: The Alliance Commercial |
$10,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRIVER 3.4MM SPADE 214-00-009
|
Facility
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5248638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRIVER BIT GRIDLOCK 320-35-003
|
Facility
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5459735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
DRIVER BIT GRIDLOCK 320-35-003
|
Facility
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5459735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
DRIVER GRIDLOCK 317-24-003
|
Facility
OP
|
$2,585.00
|
|
| Hospital Charge Code |
5547441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.80 |
| Max. Negotiated Rate |
$10,340.00 |
| 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: The Alliance Commercial |
$10,340.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
