|
DRILL BIT 2.8MM PERCUTANEOUS 324.214
|
Facility
|
OP
|
$2,903.00
|
|
| Hospital Charge Code |
2966192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.84 |
| Max. Negotiated Rate |
$11,612.00 |
| Rate for Payer: Aetna Commercial |
$2,612.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,496.58
|
| Rate for Payer: Aetna Managed Medicare |
$812.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,393.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.59
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,670.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,624.52
|
| Rate for Payer: Health EOS Commercial |
$2,583.67
|
| Rate for Payer: HFN Commercial |
$2,670.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,177.25
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,670.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.47
|
| Rate for Payer: Quartz Commercial |
$1,886.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.80
|
| Rate for Payer: The Alliance Commercial |
$11,612.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.65
|
| Rate for Payer: WPS Commercial |
$2,150.25
|
|
|
DRILL BIT 2.8MM PERCUTANEOUS 324.214
|
Facility
|
IP
|
$2,903.00
|
|
| Hospital Charge Code |
2966192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,422.47 |
| Max. Negotiated Rate |
$2,670.76 |
| Rate for Payer: Aetna Commercial |
$2,612.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,496.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.59
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,670.76
|
| Rate for Payer: Health EOS Commercial |
$2,583.67
|
| Rate for Payer: HFN Commercial |
$2,670.76
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,670.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.47
|
| Rate for Payer: Quartz Commercial |
$1,741.80
|
| Rate for Payer: WEA Trust Commercial |
$1,596.65
|
| Rate for Payer: WPS Commercial |
$2,150.25
|
|
|
DRILL BIT 2.8MM X 5 IN QUICK RELEASE 80-2008
|
Facility
|
OP
|
$2,118.00
|
|
| Hospital Charge Code |
6181298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$8,472.00 |
| Rate for Payer: Aetna Commercial |
$1,906.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,821.48
|
| Rate for Payer: Aetna Managed Medicare |
$593.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,376.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,059.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,016.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.54
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$1,948.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.23
|
| Rate for Payer: Health EOS Commercial |
$1,885.02
|
| Rate for Payer: HFN Commercial |
$1,948.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,588.50
|
| Rate for Payer: Multiplan Commercial |
$1,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,948.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.82
|
| Rate for Payer: Quartz Commercial |
$1,376.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,270.80
|
| Rate for Payer: The Alliance Commercial |
$8,472.00
|
| Rate for Payer: WEA Trust Commercial |
$1,164.90
|
| Rate for Payer: WPS Commercial |
$1,568.80
|
|
|
DRILL BIT 2.8MM X 5 IN QUICK RELEASE 80-2008
|
Facility
|
IP
|
$2,118.00
|
|
| Hospital Charge Code |
6181298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,037.82 |
| Max. Negotiated Rate |
$1,948.56 |
| Rate for Payer: Aetna Commercial |
$1,906.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,821.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.54
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$1,948.56
|
| Rate for Payer: Health EOS Commercial |
$1,885.02
|
| Rate for Payer: HFN Commercial |
$1,948.56
|
| Rate for Payer: Multiplan Commercial |
$1,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,948.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.82
|
| Rate for Payer: Quartz Commercial |
$1,270.80
|
| Rate for Payer: WEA Trust Commercial |
$1,164.90
|
| Rate for Payer: WPS Commercial |
$1,568.80
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.106
|
Facility
|
OP
|
$1,642.42
|
|
| Hospital Charge Code |
6220226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.88 |
| Max. Negotiated Rate |
$6,569.68 |
| Rate for Payer: Aetna Commercial |
$1,478.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.48
|
| Rate for Payer: Aetna Managed Medicare |
$459.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,067.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$821.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$788.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.48
|
| Rate for Payer: Cash Price |
$492.73
|
| Rate for Payer: Cigna Commercial |
$1,511.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.10
|
| Rate for Payer: Health EOS Commercial |
$1,461.75
|
| Rate for Payer: HFN Commercial |
$1,511.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,231.82
|
| Rate for Payer: Multiplan Commercial |
$1,313.94
|
| Rate for Payer: NAPHCARE Commercial |
$985.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,511.03
|
| Rate for Payer: Quartz Beloit One Network |
$804.79
|
| Rate for Payer: Quartz Commercial |
$1,067.57
|
| Rate for Payer: Quartz Medicare Advantage |
$985.45
|
| Rate for Payer: The Alliance Commercial |
$6,569.68
|
| Rate for Payer: WEA Trust Commercial |
$903.33
|
| Rate for Payer: WPS Commercial |
$1,216.54
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.106
|
Facility
|
IP
|
$1,642.42
|
|
| Hospital Charge Code |
6220226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.79 |
| Max. Negotiated Rate |
$1,511.03 |
| Rate for Payer: Aetna Commercial |
$1,478.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.48
|
| Rate for Payer: Cash Price |
$492.73
|
| Rate for Payer: Cigna Commercial |
$1,511.03
|
| Rate for Payer: Health EOS Commercial |
$1,461.75
|
| Rate for Payer: HFN Commercial |
$1,511.03
|
| Rate for Payer: Multiplan Commercial |
$1,313.94
|
| Rate for Payer: NAPHCARE Commercial |
$985.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,511.03
|
| Rate for Payer: Quartz Beloit One Network |
$804.79
|
| Rate for Payer: Quartz Commercial |
$985.45
|
| Rate for Payer: WEA Trust Commercial |
$903.33
|
| Rate for Payer: WPS Commercial |
$1,216.54
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.107
|
Facility
|
OP
|
$2,032.00
|
|
| Hospital Charge Code |
6234157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.96 |
| Max. Negotiated Rate |
$8,128.00 |
| Rate for Payer: Aetna Commercial |
$1,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,747.52
|
| Rate for Payer: Aetna Managed Medicare |
$568.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.96
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$1,869.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.11
|
| Rate for Payer: Health EOS Commercial |
$1,808.48
|
| Rate for Payer: HFN Commercial |
$1,869.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.00
|
| Rate for Payer: Multiplan Commercial |
$1,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.44
|
| Rate for Payer: Quartz Beloit One Network |
$995.68
|
| Rate for Payer: Quartz Commercial |
$1,320.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.20
|
| Rate for Payer: The Alliance Commercial |
$8,128.00
|
| Rate for Payer: WEA Trust Commercial |
$1,117.60
|
| Rate for Payer: WPS Commercial |
$1,505.10
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.107
|
Facility
|
IP
|
$2,032.00
|
|
| Hospital Charge Code |
6234157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.68 |
| Max. Negotiated Rate |
$1,869.44 |
| Rate for Payer: Aetna Commercial |
$1,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,747.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.96
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$1,869.44
|
| Rate for Payer: Health EOS Commercial |
$1,808.48
|
| Rate for Payer: HFN Commercial |
$1,869.44
|
| Rate for Payer: Multiplan Commercial |
$1,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.44
|
| Rate for Payer: Quartz Beloit One Network |
$995.68
|
| Rate for Payer: Quartz Commercial |
$1,219.20
|
| Rate for Payer: WEA Trust Commercial |
$1,117.60
|
| Rate for Payer: WPS Commercial |
$1,505.10
|
|
|
DRILL BIT 2.8 QUICK COUPLING 310.288
|
Facility
|
IP
|
$1,637.00
|
|
| Hospital Charge Code |
2966191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.13 |
| Max. Negotiated Rate |
$1,506.04 |
| Rate for Payer: Aetna Commercial |
$1,473.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,407.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$867.61
|
| Rate for Payer: Cash Price |
$491.10
|
| Rate for Payer: Cigna Commercial |
$1,506.04
|
| Rate for Payer: Health EOS Commercial |
$1,456.93
|
| Rate for Payer: HFN Commercial |
$1,506.04
|
| Rate for Payer: Multiplan Commercial |
$1,309.60
|
| Rate for Payer: NAPHCARE Commercial |
$982.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.04
|
| Rate for Payer: Quartz Beloit One Network |
$802.13
|
| Rate for Payer: Quartz Commercial |
$982.20
|
| Rate for Payer: WEA Trust Commercial |
$900.35
|
| Rate for Payer: WPS Commercial |
$1,212.53
|
|
|
DRILL BIT 2.8 QUICK COUPLING 310.288
|
Facility
|
OP
|
$1,637.00
|
|
| Hospital Charge Code |
2966191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.36 |
| Max. Negotiated Rate |
$6,548.00 |
| Rate for Payer: Aetna Commercial |
$1,473.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,407.82
|
| Rate for Payer: Aetna Managed Medicare |
$458.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$818.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$785.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$867.61
|
| Rate for Payer: Cash Price |
$491.10
|
| Rate for Payer: Cigna Commercial |
$1,506.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.07
|
| Rate for Payer: Health EOS Commercial |
$1,456.93
|
| Rate for Payer: HFN Commercial |
$1,506.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.75
|
| Rate for Payer: Multiplan Commercial |
$1,309.60
|
| Rate for Payer: NAPHCARE Commercial |
$982.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.04
|
| Rate for Payer: Quartz Beloit One Network |
$802.13
|
| Rate for Payer: Quartz Commercial |
$1,064.05
|
| Rate for Payer: Quartz Medicare Advantage |
$982.20
|
| Rate for Payer: The Alliance Commercial |
$6,548.00
|
| Rate for Payer: WEA Trust Commercial |
$900.35
|
| Rate for Payer: WPS Commercial |
$1,212.53
|
|
|
DRILL BIT 2.8 SHORT
|
Facility
|
OP
|
$1,217.00
|
|
| Hospital Charge Code |
2964139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.76 |
| Max. Negotiated Rate |
$4,868.00 |
| Rate for Payer: Aetna Commercial |
$1,095.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.62
|
| Rate for Payer: Aetna Managed Medicare |
$340.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$791.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$584.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.01
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,119.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.03
|
| Rate for Payer: Health EOS Commercial |
$1,083.13
|
| Rate for Payer: HFN Commercial |
$1,119.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.75
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: NAPHCARE Commercial |
$730.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.64
|
| Rate for Payer: Quartz Beloit One Network |
$596.33
|
| Rate for Payer: Quartz Commercial |
$791.05
|
| Rate for Payer: Quartz Medicare Advantage |
$730.20
|
| Rate for Payer: The Alliance Commercial |
$4,868.00
|
| Rate for Payer: WEA Trust Commercial |
$669.35
|
| Rate for Payer: WPS Commercial |
$901.43
|
|
|
DRILL BIT 2.8 SHORT
|
Facility
|
IP
|
$1,217.00
|
|
| Hospital Charge Code |
2964139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.33 |
| Max. Negotiated Rate |
$1,119.64 |
| Rate for Payer: Aetna Commercial |
$1,095.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.01
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,119.64
|
| Rate for Payer: Health EOS Commercial |
$1,083.13
|
| Rate for Payer: HFN Commercial |
$1,119.64
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: NAPHCARE Commercial |
$730.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.64
|
| Rate for Payer: Quartz Beloit One Network |
$596.33
|
| Rate for Payer: Quartz Commercial |
$730.20
|
| Rate for Payer: WEA Trust Commercial |
$669.35
|
| Rate for Payer: WPS Commercial |
$901.43
|
|
|
DRILL BIT 2.8 X 60MM ORTHOLOC 58850028
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5729840
|
|
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 2.8 X 60MM ORTHOLOC 58850028
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5729840
|
|
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 IN 1 CANNULATED ATTACHMENT 159023SND
|
Facility
|
OP
|
$2,604.00
|
|
| Hospital Charge Code |
5617666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.12 |
| Max. Negotiated Rate |
$10,416.00 |
| Rate for Payer: Aetna Commercial |
$2,343.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.44
|
| Rate for Payer: Aetna Managed Medicare |
$729.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,692.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,302.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,249.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,380.12
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$2,395.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,457.20
|
| Rate for Payer: Health EOS Commercial |
$2,317.56
|
| Rate for Payer: HFN Commercial |
$2,395.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,953.00
|
| Rate for Payer: Multiplan Commercial |
$2,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.96
|
| Rate for Payer: Quartz Commercial |
$1,692.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,562.40
|
| Rate for Payer: The Alliance Commercial |
$10,416.00
|
| Rate for Payer: WEA Trust Commercial |
$1,432.20
|
| Rate for Payer: WPS Commercial |
$1,928.78
|
|
|
DRILL BIT 2 IN 1 CANNULATED ATTACHMENT 159023SND
|
Facility
|
IP
|
$2,604.00
|
|
| Hospital Charge Code |
5617666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.96 |
| Max. Negotiated Rate |
$2,395.68 |
| Rate for Payer: Aetna Commercial |
$2,343.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,380.12
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$2,395.68
|
| Rate for Payer: Health EOS Commercial |
$2,317.56
|
| Rate for Payer: HFN Commercial |
$2,395.68
|
| Rate for Payer: Multiplan Commercial |
$2,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.96
|
| Rate for Payer: Quartz Commercial |
$1,562.40
|
| Rate for Payer: WEA Trust Commercial |
$1,432.20
|
| Rate for Payer: WPS Commercial |
$1,928.78
|
|
|
DRILL BIT 2MM CANN AR-8933-20C
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5415811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
DRILL BIT 2MM CANN AR-8933-20C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5415811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
DRILL BIT 3.0 MGS STERILE AR-9628S
|
Facility
|
OP
|
$3,139.00
|
|
| Hospital Charge Code |
5603575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
DRILL BIT 3.0 MGS STERILE AR-9628S
|
Facility
|
IP
|
$3,139.00
|
|
| Hospital Charge Code |
5603575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
DRILL BIT 3.0MM AR-8943-36
|
Facility
|
IP
|
$1,531.00
|
|
| Hospital Charge Code |
5349251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
DRILL BIT 3.0MM AR-8943-36
|
Facility
|
OP
|
$1,531.00
|
|
| Hospital Charge Code |
5349251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
DRILL BIT 3.0MM CALIBRATED LONG AR-8970-30L
|
Facility
|
OP
|
$2,596.00
|
|
| Hospital Charge Code |
5603783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.88 |
| Max. Negotiated Rate |
$10,384.00 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Aetna Managed Medicare |
$726.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.00
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,687.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.60
|
| Rate for Payer: The Alliance Commercial |
$10,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
DRILL BIT 3.0MM CALIBRATED LONG AR-8970-30L
|
Facility
|
IP
|
$2,596.00
|
|
| Hospital Charge Code |
5603783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,272.04 |
| Max. Negotiated Rate |
$2,388.32 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,557.60
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
DRILL BIT 3.1 X 216MM LOCK SHORT 705031
|
Facility
|
IP
|
$1,857.00
|
|
| Hospital Charge Code |
5458970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.93 |
| Max. Negotiated Rate |
$1,708.44 |
| Rate for Payer: Aetna Commercial |
$1,671.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,597.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$984.21
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna Commercial |
$1,708.44
|
| Rate for Payer: Health EOS Commercial |
$1,652.73
|
| Rate for Payer: HFN Commercial |
$1,708.44
|
| Rate for Payer: Multiplan Commercial |
$1,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,114.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,708.44
|
| Rate for Payer: Quartz Beloit One Network |
$909.93
|
| Rate for Payer: Quartz Commercial |
$1,114.20
|
| Rate for Payer: WEA Trust Commercial |
$1,021.35
|
| Rate for Payer: WPS Commercial |
$1,375.48
|
|
