|
DRILL BIT 3.2 X145MM 700358
|
Facility
|
OP
|
$1,396.00
|
|
| Hospital Charge Code |
5459548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.88 |
| Max. Negotiated Rate |
$5,584.00 |
| Rate for Payer: Aetna Commercial |
$1,256.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,200.56
|
| Rate for Payer: Aetna Managed Medicare |
$390.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$698.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$670.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.88
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$1,284.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.20
|
| Rate for Payer: Health EOS Commercial |
$1,242.44
|
| Rate for Payer: HFN Commercial |
$1,284.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,047.00
|
| Rate for Payer: Multiplan Commercial |
$1,116.80
|
| Rate for Payer: NAPHCARE Commercial |
$837.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.32
|
| Rate for Payer: Quartz Beloit One Network |
$684.04
|
| Rate for Payer: Quartz Commercial |
$907.40
|
| Rate for Payer: Quartz Medicare Advantage |
$837.60
|
| Rate for Payer: The Alliance Commercial |
$5,584.00
|
| Rate for Payer: WEA Trust Commercial |
$767.80
|
| Rate for Payer: WPS Commercial |
$1,034.02
|
|
|
DRILL BIT 3.2 X145MM 700358
|
Facility
|
IP
|
$1,396.00
|
|
| Hospital Charge Code |
5459548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.04 |
| Max. Negotiated Rate |
$1,284.32 |
| Rate for Payer: Aetna Commercial |
$1,256.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,200.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.88
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$1,284.32
|
| Rate for Payer: Health EOS Commercial |
$1,242.44
|
| Rate for Payer: HFN Commercial |
$1,284.32
|
| Rate for Payer: Multiplan Commercial |
$1,116.80
|
| Rate for Payer: NAPHCARE Commercial |
$837.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.32
|
| Rate for Payer: Quartz Beloit One Network |
$684.04
|
| Rate for Payer: Quartz Commercial |
$837.60
|
| Rate for Payer: WEA Trust Commercial |
$767.80
|
| Rate for Payer: WPS Commercial |
$1,034.02
|
|
|
DRILL BIT 3.2 X 216MM NON-LOCKING SHORT 705032
|
Facility
|
IP
|
$3,349.00
|
|
| Hospital Charge Code |
5106959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.01 |
| Max. Negotiated Rate |
$3,081.08 |
| Rate for Payer: Aetna Commercial |
$3,014.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,880.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,774.97
|
| Rate for Payer: Cash Price |
$1,004.70
|
| Rate for Payer: Cigna Commercial |
$3,081.08
|
| Rate for Payer: Health EOS Commercial |
$2,980.61
|
| Rate for Payer: HFN Commercial |
$3,081.08
|
| Rate for Payer: Multiplan Commercial |
$2,679.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,009.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,081.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.01
|
| Rate for Payer: Quartz Commercial |
$2,009.40
|
| Rate for Payer: WEA Trust Commercial |
$1,841.95
|
| Rate for Payer: WPS Commercial |
$2,480.60
|
|
|
DRILL BIT 3.2 X 216MM NON-LOCKING SHORT 705032
|
Facility
|
OP
|
$3,349.00
|
|
| Hospital Charge Code |
5106959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.72 |
| Max. Negotiated Rate |
$13,396.00 |
| Rate for Payer: Aetna Commercial |
$3,014.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,880.14
|
| Rate for Payer: Aetna Managed Medicare |
$937.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,176.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,674.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,607.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,774.97
|
| Rate for Payer: Cash Price |
$1,004.70
|
| Rate for Payer: Cigna Commercial |
$3,081.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,874.10
|
| Rate for Payer: Health EOS Commercial |
$2,980.61
|
| Rate for Payer: HFN Commercial |
$3,081.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.75
|
| Rate for Payer: Multiplan Commercial |
$2,679.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,009.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,081.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.01
|
| Rate for Payer: Quartz Commercial |
$2,176.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,009.40
|
| Rate for Payer: The Alliance Commercial |
$13,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,841.95
|
| Rate for Payer: WPS Commercial |
$2,480.60
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060
|
Facility
|
IP
|
$3,328.00
|
|
| Hospital Charge Code |
2966194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,630.72 |
| Max. Negotiated Rate |
$3,061.76 |
| Rate for Payer: Aetna Commercial |
$2,995.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.84
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$3,061.76
|
| Rate for Payer: Health EOS Commercial |
$2,961.92
|
| Rate for Payer: HFN Commercial |
$3,061.76
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,996.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,061.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.72
|
| Rate for Payer: Quartz Commercial |
$1,996.80
|
| Rate for Payer: WEA Trust Commercial |
$1,830.40
|
| Rate for Payer: WPS Commercial |
$2,465.05
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060
|
Facility
|
OP
|
$3,328.00
|
|
| Hospital Charge Code |
2966194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.84 |
| Max. Negotiated Rate |
$13,312.00 |
| Rate for Payer: Aetna Commercial |
$2,995.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.08
|
| Rate for Payer: Aetna Managed Medicare |
$931.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,163.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,664.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,597.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.84
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$3,061.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,862.35
|
| Rate for Payer: Health EOS Commercial |
$2,961.92
|
| Rate for Payer: HFN Commercial |
$3,061.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,496.00
|
| Rate for Payer: Multiplan Commercial |
$2,662.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,996.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,061.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.72
|
| Rate for Payer: Quartz Commercial |
$2,163.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,996.80
|
| Rate for Payer: The Alliance Commercial |
$13,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,830.40
|
| Rate for Payer: WPS Commercial |
$2,465.05
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060S
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2966193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,763.44 |
| Max. Negotiated Rate |
$25,192.00 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,763.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,093.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,023.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,524.36
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,723.50
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$4,093.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,778.80
|
| Rate for Payer: The Alliance Commercial |
$25,192.00
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060S
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2966193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,086.02 |
| Max. Negotiated Rate |
$5,794.16 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$3,778.80
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
DRILL BIT 3.4MM SPADE PILOT 214-00-006
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3713498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
DRILL BIT 3.4MM SPADE PILOT 214-00-006
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3713498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$12,664.00 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Aetna Managed Medicare |
$886.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,771.69
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,374.50
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$2,057.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,899.60
|
| Rate for Payer: The Alliance Commercial |
$12,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
DRILL BIT 3.5MM ARTHREX AR-4160-35
|
Facility
|
IP
|
$1,263.00
|
|
| Hospital Charge Code |
5416037
|
|
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 3.5MM ARTHREX AR-4160-35
|
Facility
|
OP
|
$1,263.00
|
|
| Hospital Charge Code |
5416037
|
|
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 3.5MM CALIBRATED AR-8956C-35PD
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5599720
|
|
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 3.5MM CALIBRATED AR-8956C-35PD
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5599720
|
|
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 3.5MM CANN TWIST 702450
|
Facility
|
OP
|
$2,256.00
|
|
| Hospital Charge Code |
5582937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$9,024.00 |
| Rate for Payer: Aetna Commercial |
$2,030.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,940.16
|
| Rate for Payer: Aetna Managed Medicare |
$631.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,466.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.68
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,075.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,262.46
|
| Rate for Payer: Health EOS Commercial |
$2,007.84
|
| Rate for Payer: HFN Commercial |
$2,075.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,692.00
|
| Rate for Payer: Multiplan Commercial |
$1,804.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,075.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.44
|
| Rate for Payer: Quartz Commercial |
$1,466.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,353.60
|
| Rate for Payer: The Alliance Commercial |
$9,024.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.80
|
| Rate for Payer: WPS Commercial |
$1,671.02
|
|
|
DRILL BIT 3.5MM CANN TWIST 702450
|
Facility
|
IP
|
$2,256.00
|
|
| Hospital Charge Code |
5582937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,105.44 |
| Max. Negotiated Rate |
$2,075.52 |
| Rate for Payer: Aetna Commercial |
$2,030.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,940.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.68
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,075.52
|
| Rate for Payer: Health EOS Commercial |
$2,007.84
|
| Rate for Payer: HFN Commercial |
$2,075.52
|
| Rate for Payer: Multiplan Commercial |
$1,804.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,075.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.44
|
| Rate for Payer: Quartz Commercial |
$1,353.60
|
| Rate for Payer: WEA Trust Commercial |
$1,240.80
|
| Rate for Payer: WPS Commercial |
$1,671.02
|
|
|
DRILL BIT 3.5MM X12.7CM 00-2318-035-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
5349273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.72 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$751.64
|
| Rate for Payer: Aetna Managed Medicare |
$244.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$419.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.22
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$804.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.09
|
| Rate for Payer: Health EOS Commercial |
$777.86
|
| Rate for Payer: HFN Commercial |
$804.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$655.50
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: NAPHCARE Commercial |
$524.40
|
| Rate for Payer: Preferred Network Access Commercial |
$804.08
|
| Rate for Payer: Quartz Beloit One Network |
$428.26
|
| Rate for Payer: Quartz Commercial |
$568.10
|
| Rate for Payer: Quartz Medicare Advantage |
$524.40
|
| Rate for Payer: The Alliance Commercial |
$3,496.00
|
| Rate for Payer: WEA Trust Commercial |
$480.70
|
| Rate for Payer: WPS Commercial |
$647.37
|
|
|
DRILL BIT 3.5MM X12.7CM 00-2318-035-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
5349273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.26 |
| Max. Negotiated Rate |
$804.08 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$751.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.22
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$804.08
|
| Rate for Payer: Health EOS Commercial |
$777.86
|
| Rate for Payer: HFN Commercial |
$804.08
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: NAPHCARE Commercial |
$524.40
|
| Rate for Payer: Preferred Network Access Commercial |
$804.08
|
| Rate for Payer: Quartz Beloit One Network |
$428.26
|
| Rate for Payer: Quartz Commercial |
$524.40
|
| Rate for Payer: WEA Trust Commercial |
$480.70
|
| Rate for Payer: WPS Commercial |
$647.37
|
|
|
DRILL BIT 3.5MM X 195MM 310.37
|
Facility
|
OP
|
$1,098.00
|
|
| Hospital Charge Code |
3265480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.44 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$988.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$944.28
|
| Rate for Payer: Aetna Managed Medicare |
$307.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$713.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$549.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$527.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.94
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna Commercial |
$1,010.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$614.44
|
| Rate for Payer: Health EOS Commercial |
$977.22
|
| Rate for Payer: HFN Commercial |
$1,010.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$823.50
|
| Rate for Payer: Multiplan Commercial |
$878.40
|
| Rate for Payer: NAPHCARE Commercial |
$658.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,010.16
|
| Rate for Payer: Quartz Beloit One Network |
$538.02
|
| Rate for Payer: Quartz Commercial |
$713.70
|
| Rate for Payer: Quartz Medicare Advantage |
$658.80
|
| Rate for Payer: The Alliance Commercial |
$4,392.00
|
| Rate for Payer: WEA Trust Commercial |
$603.90
|
| Rate for Payer: WPS Commercial |
$813.29
|
|
|
DRILL BIT 3.5MM X 195MM 310.37
|
Facility
|
IP
|
$1,098.00
|
|
| Hospital Charge Code |
3265480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.02 |
| Max. Negotiated Rate |
$1,010.16 |
| Rate for Payer: Aetna Commercial |
$988.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$944.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.94
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna Commercial |
$1,010.16
|
| Rate for Payer: Health EOS Commercial |
$977.22
|
| Rate for Payer: HFN Commercial |
$1,010.16
|
| Rate for Payer: Multiplan Commercial |
$878.40
|
| Rate for Payer: NAPHCARE Commercial |
$658.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,010.16
|
| Rate for Payer: Quartz Beloit One Network |
$538.02
|
| Rate for Payer: Quartz Commercial |
$658.80
|
| Rate for Payer: WEA Trust Commercial |
$603.90
|
| Rate for Payer: WPS Commercial |
$813.29
|
|
|
DRILL BIT 3.5 X 110 QUICK COUPLE 310.35
|
Facility
|
OP
|
$1,402.00
|
|
| Hospital Charge Code |
2966199
|
|
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
|
|
|
DRILL BIT 3.5 X 110 QUICK COUPLE 310.35
|
Facility
|
IP
|
$1,402.00
|
|
| Hospital Charge Code |
2966199
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,205.72
|
| 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 BIT 3.5 X 230MM AO 1806-3540S
|
Facility
|
IP
|
$1,385.00
|
|
| Hospital Charge Code |
6204988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.65 |
| Max. Negotiated Rate |
$1,274.20 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$831.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
DRILL BIT 3.5 X 230MM AO 1806-3540S
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
6204988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$5,540.00 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Aetna Managed Medicare |
$387.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$900.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$692.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$664.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.05
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.75
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$900.25
|
| Rate for Payer: Quartz Medicare Advantage |
$831.00
|
| Rate for Payer: The Alliance Commercial |
$5,540.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
DRILL BIT 3.5 X 60MM ORTHOLOC 58850035
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5729841
|
|
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
|
|
