|
DRILL BIT 3.5 X 60MM ORTHOLOC 58850035
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5729841
|
|
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 3.8MM ORTHOLOC 59250038
|
Facility
|
OP
|
$1,948.00
|
|
| Hospital Charge Code |
6201065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.44 |
| Max. Negotiated Rate |
$7,792.00 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Aetna Managed Medicare |
$545.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,266.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$974.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$935.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,090.10
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,461.00
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,266.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.80
|
| Rate for Payer: The Alliance Commercial |
$7,792.00
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
DRILL BIT 3.8MM ORTHOLOC 59250038
|
Facility
|
IP
|
$1,948.00
|
|
| Hospital Charge Code |
6201065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.52 |
| Max. Negotiated Rate |
$1,792.16 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,168.80
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
DRILL BIT 3.8 THREE-FLUTED 03.019.016
|
Facility
|
OP
|
$2,791.00
|
|
| Hospital Charge Code |
3000351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.48 |
| Max. Negotiated Rate |
$11,164.00 |
| Rate for Payer: Aetna Commercial |
$2,511.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,400.26
|
| Rate for Payer: Aetna Managed Medicare |
$781.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,814.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,479.23
|
| Rate for Payer: Cash Price |
$837.30
|
| Rate for Payer: Cigna Commercial |
$2,567.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.84
|
| Rate for Payer: Health EOS Commercial |
$2,483.99
|
| Rate for Payer: HFN Commercial |
$2,567.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,093.25
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.59
|
| Rate for Payer: Quartz Commercial |
$1,814.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.60
|
| Rate for Payer: The Alliance Commercial |
$11,164.00
|
| Rate for Payer: WEA Trust Commercial |
$1,535.05
|
| Rate for Payer: WPS Commercial |
$2,067.29
|
|
|
DRILL BIT 3.8 THREE-FLUTED 03.019.016
|
Facility
|
IP
|
$2,791.00
|
|
| Hospital Charge Code |
3000351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,367.59 |
| Max. Negotiated Rate |
$2,567.72 |
| Rate for Payer: Aetna Commercial |
$2,511.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,400.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,479.23
|
| Rate for Payer: Cash Price |
$837.30
|
| Rate for Payer: Cigna Commercial |
$2,567.72
|
| Rate for Payer: Health EOS Commercial |
$2,483.99
|
| Rate for Payer: HFN Commercial |
$2,567.72
|
| Rate for Payer: Multiplan Commercial |
$2,232.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.59
|
| Rate for Payer: Quartz Commercial |
$1,674.60
|
| Rate for Payer: WEA Trust Commercial |
$1,535.05
|
| Rate for Payer: WPS Commercial |
$2,067.29
|
|
|
DRILL BIT 3.9/6.0
|
Facility
|
OP
|
$6,062.00
|
|
| Hospital Charge Code |
2966201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,697.36 |
| Max. Negotiated Rate |
$24,248.00 |
| Rate for Payer: Aetna Commercial |
$5,455.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,213.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,940.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,031.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,909.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,212.86
|
| Rate for Payer: Cash Price |
$1,818.60
|
| Rate for Payer: Cigna Commercial |
$5,577.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,392.30
|
| Rate for Payer: Health EOS Commercial |
$5,395.18
|
| Rate for Payer: HFN Commercial |
$5,577.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,546.50
|
| Rate for Payer: Multiplan Commercial |
$4,849.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.38
|
| Rate for Payer: Quartz Commercial |
$3,940.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,637.20
|
| Rate for Payer: The Alliance Commercial |
$24,248.00
|
| Rate for Payer: WEA Trust Commercial |
$3,334.10
|
| Rate for Payer: WPS Commercial |
$4,490.12
|
|
|
DRILL BIT 3.9/6.0
|
Facility
|
IP
|
$6,062.00
|
|
| Hospital Charge Code |
2966201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,970.38 |
| Max. Negotiated Rate |
$5,577.04 |
| Rate for Payer: Aetna Commercial |
$5,455.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,213.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,212.86
|
| Rate for Payer: Cash Price |
$1,818.60
|
| Rate for Payer: Cigna Commercial |
$5,577.04
|
| Rate for Payer: Health EOS Commercial |
$5,395.18
|
| Rate for Payer: HFN Commercial |
$5,577.04
|
| Rate for Payer: Multiplan Commercial |
$4,849.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.38
|
| Rate for Payer: Quartz Commercial |
$3,637.20
|
| Rate for Payer: WEA Trust Commercial |
$3,334.10
|
| Rate for Payer: WPS Commercial |
$4,490.12
|
|
|
DRILL BIT 3-FLUTED
|
Facility
|
OP
|
$2,959.00
|
|
| Hospital Charge Code |
2966202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.52 |
| Max. Negotiated Rate |
$11,836.00 |
| Rate for Payer: Aetna Commercial |
$2,663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,544.74
|
| Rate for Payer: Aetna Managed Medicare |
$828.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,923.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,420.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,568.27
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna Commercial |
$2,722.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,655.86
|
| Rate for Payer: Health EOS Commercial |
$2,633.51
|
| Rate for Payer: HFN Commercial |
$2,722.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,219.25
|
| Rate for Payer: Multiplan Commercial |
$2,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,775.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,722.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.91
|
| Rate for Payer: Quartz Commercial |
$1,923.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,775.40
|
| Rate for Payer: The Alliance Commercial |
$11,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,627.45
|
| Rate for Payer: WPS Commercial |
$2,191.73
|
|
|
DRILL BIT 3-FLUTED
|
Facility
|
IP
|
$2,959.00
|
|
| Hospital Charge Code |
2966202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,449.91 |
| Max. Negotiated Rate |
$2,722.28 |
| Rate for Payer: Aetna Commercial |
$2,663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,544.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,568.27
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna Commercial |
$2,722.28
|
| Rate for Payer: Health EOS Commercial |
$2,633.51
|
| Rate for Payer: HFN Commercial |
$2,722.28
|
| Rate for Payer: Multiplan Commercial |
$2,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,775.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,722.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,449.91
|
| Rate for Payer: Quartz Commercial |
$1,775.40
|
| Rate for Payer: WEA Trust Commercial |
$1,627.45
|
| Rate for Payer: WPS Commercial |
$2,191.73
|
|
|
DRILL BIT 3-FLUTED 3.9/4.2
|
Facility
|
OP
|
$2,445.00
|
|
| Hospital Charge Code |
2966203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.60 |
| Max. Negotiated Rate |
$9,780.00 |
| Rate for Payer: Aetna Commercial |
$2,200.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,102.70
|
| Rate for Payer: Aetna Managed Medicare |
$684.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,295.85
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$2,249.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,368.22
|
| Rate for Payer: Health EOS Commercial |
$2,176.05
|
| Rate for Payer: HFN Commercial |
$2,249.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,833.75
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,467.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,249.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,198.05
|
| Rate for Payer: Quartz Commercial |
$1,589.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,467.00
|
| Rate for Payer: The Alliance Commercial |
$9,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,344.75
|
| Rate for Payer: WPS Commercial |
$1,811.01
|
|
|
DRILL BIT 3-FLUTED 3.9/4.2
|
Facility
|
IP
|
$2,445.00
|
|
| Hospital Charge Code |
2966203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,198.05 |
| Max. Negotiated Rate |
$2,249.40 |
| Rate for Payer: Aetna Commercial |
$2,200.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,102.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,295.85
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$2,249.40
|
| Rate for Payer: Health EOS Commercial |
$2,176.05
|
| Rate for Payer: HFN Commercial |
$2,249.40
|
| Rate for Payer: Multiplan Commercial |
$1,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,467.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,249.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,198.05
|
| Rate for Payer: Quartz Commercial |
$1,467.00
|
| Rate for Payer: WEA Trust Commercial |
$1,344.75
|
| Rate for Payer: WPS Commercial |
$1,811.01
|
|
|
DRILL BIT 3-FLUTED 4.0x260 357.407
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2969384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
DRILL BIT 3-FLUTED 4.0x260 357.407
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2969384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
DRILL BIT 3MM CANN AR-8933-30C
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5459540
|
|
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 3MM CANN AR-8933-30C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5459540
|
|
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 4.0MM 3-FLUTED 315.40
|
Facility
|
IP
|
$2,244.00
|
|
| Hospital Charge Code |
2966205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,099.56 |
| Max. Negotiated Rate |
$2,064.48 |
| Rate for Payer: Aetna Commercial |
$2,019.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,189.32
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$2,064.48
|
| Rate for Payer: Health EOS Commercial |
$1,997.16
|
| Rate for Payer: HFN Commercial |
$2,064.48
|
| Rate for Payer: Multiplan Commercial |
$1,795.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,346.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,064.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,099.56
|
| Rate for Payer: Quartz Commercial |
$1,346.40
|
| Rate for Payer: WEA Trust Commercial |
$1,234.20
|
| Rate for Payer: WPS Commercial |
$1,662.13
|
|
|
DRILL BIT 4.0MM 3-FLUTED 315.40
|
Facility
|
OP
|
$2,244.00
|
|
| Hospital Charge Code |
2966205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.32 |
| Max. Negotiated Rate |
$8,976.00 |
| Rate for Payer: Aetna Commercial |
$2,019.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,929.84
|
| Rate for Payer: Aetna Managed Medicare |
$628.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,458.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,122.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,077.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,189.32
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$2,064.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,255.74
|
| Rate for Payer: Health EOS Commercial |
$1,997.16
|
| Rate for Payer: HFN Commercial |
$2,064.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,683.00
|
| Rate for Payer: Multiplan Commercial |
$1,795.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,346.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,064.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,099.56
|
| Rate for Payer: Quartz Commercial |
$1,458.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,346.40
|
| Rate for Payer: The Alliance Commercial |
$8,976.00
|
| Rate for Payer: WEA Trust Commercial |
$1,234.20
|
| Rate for Payer: WPS Commercial |
$1,662.13
|
|
|
DRILL BIT 4.0MM AR-4160-40
|
Facility
|
OP
|
$1,600.00
|
|
| Hospital Charge Code |
5591336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$6,400.00 |
| Rate for Payer: Aetna Commercial |
$1,440.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.00
|
| Rate for Payer: Aetna Managed Medicare |
$448.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,472.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.36
|
| Rate for Payer: Health EOS Commercial |
$1,424.00
|
| Rate for Payer: HFN Commercial |
$1,472.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: NAPHCARE Commercial |
$960.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.00
|
| Rate for Payer: Quartz Beloit One Network |
$784.00
|
| Rate for Payer: Quartz Commercial |
$1,040.00
|
| Rate for Payer: Quartz Medicare Advantage |
$960.00
|
| Rate for Payer: The Alliance Commercial |
$6,400.00
|
| Rate for Payer: WEA Trust Commercial |
$880.00
|
| Rate for Payer: WPS Commercial |
$1,185.12
|
|
|
DRILL BIT 4.0MM AR-4160-40
|
Facility
|
IP
|
$1,600.00
|
|
| Hospital Charge Code |
5591336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$1,440.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,472.00
|
| Rate for Payer: Health EOS Commercial |
$1,424.00
|
| Rate for Payer: HFN Commercial |
$1,472.00
|
| Rate for Payer: Multiplan Commercial |
$1,280.00
|
| Rate for Payer: NAPHCARE Commercial |
$960.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.00
|
| Rate for Payer: Quartz Beloit One Network |
$784.00
|
| Rate for Payer: Quartz Commercial |
$960.00
|
| Rate for Payer: WEA Trust Commercial |
$880.00
|
| Rate for Payer: WPS Commercial |
$1,185.12
|
|
|
DRILL BIT 4.0MM X 200MM 5085-2-040
|
Facility
|
IP
|
$1,909.00
|
|
| Hospital Charge Code |
5685713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$935.41 |
| Max. Negotiated Rate |
$1,756.28 |
| Rate for Payer: Aetna Commercial |
$1,718.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,641.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,011.77
|
| Rate for Payer: Cash Price |
$572.70
|
| Rate for Payer: Cigna Commercial |
$1,756.28
|
| Rate for Payer: Health EOS Commercial |
$1,699.01
|
| Rate for Payer: HFN Commercial |
$1,756.28
|
| Rate for Payer: Multiplan Commercial |
$1,527.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,145.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,756.28
|
| Rate for Payer: Quartz Beloit One Network |
$935.41
|
| Rate for Payer: Quartz Commercial |
$1,145.40
|
| Rate for Payer: WEA Trust Commercial |
$1,049.95
|
| Rate for Payer: WPS Commercial |
$1,414.00
|
|
|
DRILL BIT 4.0MM X 200MM 5085-2-040
|
Facility
|
OP
|
$1,909.00
|
|
| Hospital Charge Code |
5685713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$534.52 |
| Max. Negotiated Rate |
$7,636.00 |
| Rate for Payer: Aetna Commercial |
$1,718.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,641.74
|
| Rate for Payer: Aetna Managed Medicare |
$534.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,240.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$954.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$916.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,011.77
|
| Rate for Payer: Cash Price |
$572.70
|
| Rate for Payer: Cigna Commercial |
$1,756.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,068.28
|
| Rate for Payer: Health EOS Commercial |
$1,699.01
|
| Rate for Payer: HFN Commercial |
$1,756.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,431.75
|
| Rate for Payer: Multiplan Commercial |
$1,527.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,145.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,756.28
|
| Rate for Payer: Quartz Beloit One Network |
$935.41
|
| Rate for Payer: Quartz Commercial |
$1,240.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,145.40
|
| Rate for Payer: The Alliance Commercial |
$7,636.00
|
| Rate for Payer: WEA Trust Commercial |
$1,049.95
|
| Rate for Payer: WPS Commercial |
$1,414.00
|
|
|
DRILL BIT 4.0 X 60MM ORTHOLOC 58850040
|
Facility
|
OP
|
$1,954.00
|
|
| Hospital Charge Code |
6206992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.12 |
| Max. Negotiated Rate |
$7,816.00 |
| Rate for Payer: Aetna Commercial |
$1,758.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,680.44
|
| Rate for Payer: Aetna Managed Medicare |
$547.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,270.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$977.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.62
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$1,797.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.46
|
| Rate for Payer: Health EOS Commercial |
$1,739.06
|
| Rate for Payer: HFN Commercial |
$1,797.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.50
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,172.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,797.68
|
| Rate for Payer: Quartz Beloit One Network |
$957.46
|
| Rate for Payer: Quartz Commercial |
$1,270.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,172.40
|
| Rate for Payer: The Alliance Commercial |
$7,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,074.70
|
| Rate for Payer: WPS Commercial |
$1,447.33
|
|
|
DRILL BIT 4.0 X 60MM ORTHOLOC 58850040
|
Facility
|
IP
|
$1,954.00
|
|
| Hospital Charge Code |
6206992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.46 |
| Max. Negotiated Rate |
$1,797.68 |
| Rate for Payer: Aetna Commercial |
$1,758.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,680.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.62
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$1,797.68
|
| Rate for Payer: Health EOS Commercial |
$1,739.06
|
| Rate for Payer: HFN Commercial |
$1,797.68
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,172.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,797.68
|
| Rate for Payer: Quartz Beloit One Network |
$957.46
|
| Rate for Payer: Quartz Commercial |
$1,172.40
|
| Rate for Payer: WEA Trust Commercial |
$1,074.70
|
| Rate for Payer: WPS Commercial |
$1,447.33
|
|
|
DRILL BIT 4.2 3-FLUTED NDL PT
|
Facility
|
IP
|
$2,945.00
|
|
| Hospital Charge Code |
2966206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
DRILL BIT 4.2 3-FLUTED NDL PT
|
Facility
|
OP
|
$2,945.00
|
|
| Hospital Charge Code |
2966206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$11,780.00 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$824.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,914.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,208.75
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.00
|
| Rate for Payer: The Alliance Commercial |
$11,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
