|
DRILL BIT 4.2 3-FLUTED NEEDLE POINT 03.010.104S
|
Facility
|
OP
|
$2,632.00
|
|
| Hospital Charge Code |
2966204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$736.96 |
| Max. Negotiated Rate |
$10,528.00 |
| Rate for Payer: Aetna Commercial |
$2,368.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,263.52
|
| Rate for Payer: Aetna Managed Medicare |
$736.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,710.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,316.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,263.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,394.96
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$2,421.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,472.87
|
| Rate for Payer: Health EOS Commercial |
$2,342.48
|
| Rate for Payer: HFN Commercial |
$2,421.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,974.00
|
| Rate for Payer: Multiplan Commercial |
$2,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,579.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,421.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,289.68
|
| Rate for Payer: Quartz Commercial |
$1,710.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,579.20
|
| Rate for Payer: The Alliance Commercial |
$10,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,447.60
|
| Rate for Payer: WPS Commercial |
$1,949.52
|
|
|
DRILL BIT 4.2 3-FLUTED NEEDLE POINT 03.010.104S
|
Facility
|
IP
|
$2,632.00
|
|
| Hospital Charge Code |
2966204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.68 |
| Max. Negotiated Rate |
$2,421.44 |
| Rate for Payer: Aetna Commercial |
$2,368.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,263.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,394.96
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$2,421.44
|
| Rate for Payer: Health EOS Commercial |
$2,342.48
|
| Rate for Payer: HFN Commercial |
$2,421.44
|
| Rate for Payer: Multiplan Commercial |
$2,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,579.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,421.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,289.68
|
| Rate for Payer: Quartz Commercial |
$1,579.20
|
| Rate for Payer: WEA Trust Commercial |
$1,447.60
|
| Rate for Payer: WPS Commercial |
$1,949.52
|
|
|
DRILL BIT 4.2 CALIBRATED XTR-LG 03.045.022S
|
Facility
|
IP
|
$3,578.00
|
|
| Hospital Charge Code |
6175469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,753.22 |
| Max. Negotiated Rate |
$3,291.76 |
| Rate for Payer: Aetna Commercial |
$3,220.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,077.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,896.34
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$3,291.76
|
| Rate for Payer: Health EOS Commercial |
$3,184.42
|
| Rate for Payer: HFN Commercial |
$3,291.76
|
| Rate for Payer: Multiplan Commercial |
$2,862.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,146.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,291.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,753.22
|
| Rate for Payer: Quartz Commercial |
$2,146.80
|
| Rate for Payer: WEA Trust Commercial |
$1,967.90
|
| Rate for Payer: WPS Commercial |
$2,650.22
|
|
|
DRILL BIT 4.2 CALIBRATED XTR-LG 03.045.022S
|
Facility
|
OP
|
$3,578.00
|
|
| Hospital Charge Code |
6175469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,001.84 |
| Max. Negotiated Rate |
$14,312.00 |
| Rate for Payer: Aetna Commercial |
$3,220.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,077.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,001.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,325.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,789.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,717.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,896.34
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$3,291.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,002.25
|
| Rate for Payer: Health EOS Commercial |
$3,184.42
|
| Rate for Payer: HFN Commercial |
$3,291.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,683.50
|
| Rate for Payer: Multiplan Commercial |
$2,862.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,146.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,291.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,753.22
|
| Rate for Payer: Quartz Commercial |
$2,325.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,146.80
|
| Rate for Payer: The Alliance Commercial |
$14,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,967.90
|
| Rate for Payer: WPS Commercial |
$2,650.22
|
|
|
DRILL BIT 4.2MM 3-FLUTED 03.010.61S
|
Facility
|
OP
|
$3,457.00
|
|
| Hospital Charge Code |
2966207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$967.96 |
| Max. Negotiated Rate |
$13,828.00 |
| Rate for Payer: Aetna Commercial |
$3,111.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.02
|
| Rate for Payer: Aetna Managed Medicare |
$967.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,247.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,728.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,659.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.21
|
| Rate for Payer: Cash Price |
$1,037.10
|
| Rate for Payer: Cigna Commercial |
$3,180.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,934.54
|
| Rate for Payer: Health EOS Commercial |
$3,076.73
|
| Rate for Payer: HFN Commercial |
$3,180.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,592.75
|
| Rate for Payer: Multiplan Commercial |
$2,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,180.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.93
|
| Rate for Payer: Quartz Commercial |
$2,247.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,074.20
|
| Rate for Payer: The Alliance Commercial |
$13,828.00
|
| Rate for Payer: WEA Trust Commercial |
$1,901.35
|
| Rate for Payer: WPS Commercial |
$2,560.60
|
|
|
DRILL BIT 4.2MM 3-FLUTED 03.010.61S
|
Facility
|
IP
|
$3,457.00
|
|
| Hospital Charge Code |
2966207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,693.93 |
| Max. Negotiated Rate |
$3,180.44 |
| Rate for Payer: Aetna Commercial |
$3,111.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.21
|
| Rate for Payer: Cash Price |
$1,037.10
|
| Rate for Payer: Cigna Commercial |
$3,180.44
|
| Rate for Payer: Health EOS Commercial |
$3,076.73
|
| Rate for Payer: HFN Commercial |
$3,180.44
|
| Rate for Payer: Multiplan Commercial |
$2,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,180.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.93
|
| Rate for Payer: Quartz Commercial |
$2,074.20
|
| Rate for Payer: WEA Trust Commercial |
$1,901.35
|
| Rate for Payer: WPS Commercial |
$2,560.60
|
|
|
DRILL BIT 4.2 RADIOLUCENT 4200-355-042
|
Facility
|
OP
|
$2,117.00
|
|
| Hospital Charge Code |
3287471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.76 |
| Max. Negotiated Rate |
$8,468.00 |
| Rate for Payer: Aetna Commercial |
$1,905.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,820.62
|
| Rate for Payer: Aetna Managed Medicare |
$592.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,376.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,058.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,016.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.01
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$1,947.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,184.67
|
| Rate for Payer: Health EOS Commercial |
$1,884.13
|
| Rate for Payer: HFN Commercial |
$1,947.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,587.75
|
| Rate for Payer: Multiplan Commercial |
$1,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,947.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.33
|
| Rate for Payer: Quartz Commercial |
$1,376.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,270.20
|
| Rate for Payer: The Alliance Commercial |
$8,468.00
|
| Rate for Payer: WEA Trust Commercial |
$1,164.35
|
| Rate for Payer: WPS Commercial |
$1,568.06
|
|
|
DRILL BIT 4.2 RADIOLUCENT 4200-355-042
|
Facility
|
IP
|
$2,117.00
|
|
| Hospital Charge Code |
3287471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,037.33 |
| Max. Negotiated Rate |
$1,947.64 |
| Rate for Payer: Aetna Commercial |
$1,905.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,820.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.01
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$1,947.64
|
| Rate for Payer: Health EOS Commercial |
$1,884.13
|
| Rate for Payer: HFN Commercial |
$1,947.64
|
| Rate for Payer: Multiplan Commercial |
$1,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,947.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.33
|
| Rate for Payer: Quartz Commercial |
$1,270.20
|
| Rate for Payer: WEA Trust Commercial |
$1,164.35
|
| Rate for Payer: WPS Commercial |
$1,568.06
|
|
|
DRILL BIT 4.2 X 130 AO 1806-4280S
|
Facility
|
OP
|
$3,326.00
|
|
| Hospital Charge Code |
4099049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.28 |
| Max. Negotiated Rate |
$13,304.00 |
| Rate for Payer: Aetna Commercial |
$2,993.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.36
|
| Rate for Payer: Aetna Managed Medicare |
$931.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,663.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.78
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,059.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,861.23
|
| Rate for Payer: Health EOS Commercial |
$2,960.14
|
| Rate for Payer: HFN Commercial |
$3,059.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,494.50
|
| Rate for Payer: Multiplan Commercial |
$2,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,995.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.74
|
| Rate for Payer: Quartz Commercial |
$2,161.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,995.60
|
| Rate for Payer: The Alliance Commercial |
$13,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,829.30
|
| Rate for Payer: WPS Commercial |
$2,463.57
|
|
|
DRILL BIT 4.2 X 130 AO 1806-4280S
|
Facility
|
IP
|
$3,326.00
|
|
| Hospital Charge Code |
4099049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,629.74 |
| Max. Negotiated Rate |
$3,059.92 |
| Rate for Payer: Aetna Commercial |
$2,993.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.78
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,059.92
|
| Rate for Payer: Health EOS Commercial |
$2,960.14
|
| Rate for Payer: HFN Commercial |
$3,059.92
|
| Rate for Payer: Multiplan Commercial |
$2,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,995.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.74
|
| Rate for Payer: Quartz Commercial |
$1,995.60
|
| Rate for Payer: WEA Trust Commercial |
$1,829.30
|
| Rate for Payer: WPS Commercial |
$2,463.57
|
|
|
DRILL BIT 4.2 X 230 AO 1806-4290S
|
Facility
|
IP
|
$1,379.00
|
|
| Hospital Charge Code |
5583321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.71 |
| Max. Negotiated Rate |
$1,268.68 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.87
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,268.68
|
| Rate for Payer: Health EOS Commercial |
$1,227.31
|
| Rate for Payer: HFN Commercial |
$1,268.68
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: NAPHCARE Commercial |
$827.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.68
|
| Rate for Payer: Quartz Beloit One Network |
$675.71
|
| Rate for Payer: Quartz Commercial |
$827.40
|
| Rate for Payer: WEA Trust Commercial |
$758.45
|
| Rate for Payer: WPS Commercial |
$1,021.43
|
|
|
DRILL BIT 4.2 X 230 AO 1806-4290S
|
Facility
|
OP
|
$1,379.00
|
|
| Hospital Charge Code |
5583321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.12 |
| Max. Negotiated Rate |
$5,516.00 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.94
|
| Rate for Payer: Aetna Managed Medicare |
$386.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$896.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.87
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,268.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.69
|
| Rate for Payer: Health EOS Commercial |
$1,227.31
|
| Rate for Payer: HFN Commercial |
$1,268.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,034.25
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: NAPHCARE Commercial |
$827.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.68
|
| Rate for Payer: Quartz Beloit One Network |
$675.71
|
| Rate for Payer: Quartz Commercial |
$896.35
|
| Rate for Payer: Quartz Medicare Advantage |
$827.40
|
| Rate for Payer: The Alliance Commercial |
$5,516.00
|
| Rate for Payer: WEA Trust Commercial |
$758.45
|
| Rate for Payer: WPS Commercial |
$1,021.43
|
|
|
DRILL BIT 4.2 X 340MM STRYKER 1806-4260S
|
Facility
|
IP
|
$2,544.00
|
|
| Hospital Charge Code |
3072607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.56 |
| Max. Negotiated Rate |
$2,340.48 |
| Rate for Payer: Aetna Commercial |
$2,289.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,187.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,348.32
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,340.48
|
| Rate for Payer: Health EOS Commercial |
$2,264.16
|
| Rate for Payer: HFN Commercial |
$2,340.48
|
| Rate for Payer: Multiplan Commercial |
$2,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,246.56
|
| Rate for Payer: Quartz Commercial |
$1,526.40
|
| Rate for Payer: WEA Trust Commercial |
$1,399.20
|
| Rate for Payer: WPS Commercial |
$1,884.34
|
|
|
DRILL BIT 4.2 X 340MM STRYKER 1806-4260S
|
Facility
|
OP
|
$2,544.00
|
|
| Hospital Charge Code |
3072607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.32 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$2,289.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,187.84
|
| Rate for Payer: Aetna Managed Medicare |
$712.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,653.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,221.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,348.32
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,340.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,423.62
|
| Rate for Payer: Health EOS Commercial |
$2,264.16
|
| Rate for Payer: HFN Commercial |
$2,340.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,908.00
|
| Rate for Payer: Multiplan Commercial |
$2,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,246.56
|
| Rate for Payer: Quartz Commercial |
$1,653.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,526.40
|
| Rate for Payer: The Alliance Commercial |
$10,176.00
|
| Rate for Payer: WEA Trust Commercial |
$1,399.20
|
| Rate for Payer: WPS Commercial |
$1,884.34
|
|
|
DRILL BIT 4.3MM X 413MM 03.168.011
|
Facility
|
IP
|
$3,922.00
|
|
| Hospital Charge Code |
6178979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,921.78 |
| Max. Negotiated Rate |
$3,608.24 |
| Rate for Payer: Aetna Commercial |
$3,529.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.66
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,608.24
|
| Rate for Payer: Health EOS Commercial |
$3,490.58
|
| Rate for Payer: HFN Commercial |
$3,608.24
|
| Rate for Payer: Multiplan Commercial |
$3,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,353.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,608.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.78
|
| Rate for Payer: Quartz Commercial |
$2,353.20
|
| Rate for Payer: WEA Trust Commercial |
$2,157.10
|
| Rate for Payer: WPS Commercial |
$2,905.03
|
|
|
DRILL BIT 4.3MM X 413MM 03.168.011
|
Facility
|
OP
|
$3,922.00
|
|
| Hospital Charge Code |
6178979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,098.16 |
| Max. Negotiated Rate |
$15,688.00 |
| Rate for Payer: Aetna Commercial |
$3,529.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,549.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,882.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.66
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,608.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,194.75
|
| Rate for Payer: Health EOS Commercial |
$3,490.58
|
| Rate for Payer: HFN Commercial |
$3,608.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,941.50
|
| Rate for Payer: Multiplan Commercial |
$3,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,353.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,608.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.78
|
| Rate for Payer: Quartz Commercial |
$2,549.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,353.20
|
| Rate for Payer: The Alliance Commercial |
$15,688.00
|
| Rate for Payer: WEA Trust Commercial |
$2,157.10
|
| Rate for Payer: WPS Commercial |
$2,905.03
|
|
|
DRILL BIT 4.3 PERCUTANEOUS 324.213
|
Facility
|
OP
|
$2,807.00
|
|
| Hospital Charge Code |
2966208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$785.96 |
| Max. Negotiated Rate |
$11,228.00 |
| Rate for Payer: Aetna Commercial |
$2,526.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.02
|
| Rate for Payer: Aetna Managed Medicare |
$785.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,824.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,403.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,347.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.71
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,582.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,570.80
|
| Rate for Payer: Health EOS Commercial |
$2,498.23
|
| Rate for Payer: HFN Commercial |
$2,582.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,105.25
|
| Rate for Payer: Multiplan Commercial |
$2,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.43
|
| Rate for Payer: Quartz Commercial |
$1,824.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.20
|
| Rate for Payer: The Alliance Commercial |
$11,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,543.85
|
| Rate for Payer: WPS Commercial |
$2,079.14
|
|
|
DRILL BIT 4.3 PERCUTANEOUS 324.213
|
Facility
|
IP
|
$2,807.00
|
|
| Hospital Charge Code |
2966208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,375.43 |
| Max. Negotiated Rate |
$2,582.44 |
| Rate for Payer: Aetna Commercial |
$2,526.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.71
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,582.44
|
| Rate for Payer: Health EOS Commercial |
$2,498.23
|
| Rate for Payer: HFN Commercial |
$2,582.44
|
| Rate for Payer: Multiplan Commercial |
$2,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.43
|
| Rate for Payer: Quartz Commercial |
$1,684.20
|
| Rate for Payer: WEA Trust Commercial |
$1,543.85
|
| Rate for Payer: WPS Commercial |
$2,079.14
|
|
|
DRILL BIT 4.3 X 180 QUICK COUPLE 310.431
|
Facility
|
IP
|
$1,832.00
|
|
| Hospital Charge Code |
2966209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$897.68 |
| Max. Negotiated Rate |
$1,685.44 |
| Rate for Payer: Aetna Commercial |
$1,648.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$970.96
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,685.44
|
| Rate for Payer: Health EOS Commercial |
$1,630.48
|
| Rate for Payer: HFN Commercial |
$1,685.44
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.44
|
| Rate for Payer: Quartz Beloit One Network |
$897.68
|
| Rate for Payer: Quartz Commercial |
$1,099.20
|
| Rate for Payer: WEA Trust Commercial |
$1,007.60
|
| Rate for Payer: WPS Commercial |
$1,356.96
|
|
|
DRILL BIT 4.3 X 180 QUICK COUPLE 310.431
|
Facility
|
OP
|
$1,832.00
|
|
| Hospital Charge Code |
2966209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$512.96 |
| Max. Negotiated Rate |
$7,328.00 |
| Rate for Payer: Aetna Commercial |
$1,648.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.52
|
| Rate for Payer: Aetna Managed Medicare |
$512.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,190.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$879.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$970.96
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,685.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.19
|
| Rate for Payer: Health EOS Commercial |
$1,630.48
|
| Rate for Payer: HFN Commercial |
$1,685.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,374.00
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.44
|
| Rate for Payer: Quartz Beloit One Network |
$897.68
|
| Rate for Payer: Quartz Commercial |
$1,190.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,099.20
|
| Rate for Payer: The Alliance Commercial |
$7,328.00
|
| Rate for Payer: WEA Trust Commercial |
$1,007.60
|
| Rate for Payer: WPS Commercial |
$1,356.96
|
|
|
DRILL BIT 4.3 X 216MM LOCKING SHORT 705043
|
Facility
|
IP
|
$4,452.00
|
|
| Hospital Charge Code |
5458804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,181.48 |
| Max. Negotiated Rate |
$4,095.84 |
| Rate for Payer: Aetna Commercial |
$4,006.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,828.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,359.56
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,095.84
|
| Rate for Payer: Health EOS Commercial |
$3,962.28
|
| Rate for Payer: HFN Commercial |
$4,095.84
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,095.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,181.48
|
| Rate for Payer: Quartz Commercial |
$2,671.20
|
| Rate for Payer: WEA Trust Commercial |
$2,448.60
|
| Rate for Payer: WPS Commercial |
$3,297.60
|
|
|
DRILL BIT 4.3 X 216MM LOCKING SHORT 705043
|
Facility
|
OP
|
$4,452.00
|
|
| Hospital Charge Code |
5458804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.56 |
| Max. Negotiated Rate |
$17,808.00 |
| Rate for Payer: Aetna Commercial |
$4,006.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,828.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,893.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,226.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,136.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,359.56
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,095.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,491.34
|
| Rate for Payer: Health EOS Commercial |
$3,962.28
|
| Rate for Payer: HFN Commercial |
$4,095.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,339.00
|
| Rate for Payer: Multiplan Commercial |
$3,561.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,095.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,181.48
|
| Rate for Payer: Quartz Commercial |
$2,893.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,671.20
|
| Rate for Payer: The Alliance Commercial |
$17,808.00
|
| Rate for Payer: WEA Trust Commercial |
$2,448.60
|
| Rate for Payer: WPS Commercial |
$3,297.60
|
|
|
DRILL BIT 4.3 X 296MM LOCKING MEDIUM 705078
|
Facility
|
IP
|
$4,404.00
|
|
| Hospital Charge Code |
5106958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,157.96 |
| Max. Negotiated Rate |
$4,051.68 |
| Rate for Payer: Aetna Commercial |
$3,963.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.12
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,051.68
|
| Rate for Payer: Health EOS Commercial |
$3,919.56
|
| Rate for Payer: HFN Commercial |
$4,051.68
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,642.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,051.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.96
|
| Rate for Payer: Quartz Commercial |
$2,642.40
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
|
DRILL BIT 4.3 X 296MM LOCKING MEDIUM 705078
|
Facility
|
OP
|
$4,404.00
|
|
| Hospital Charge Code |
5106958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,233.12 |
| Max. Negotiated Rate |
$17,616.00 |
| Rate for Payer: Aetna Commercial |
$3,963.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,233.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,862.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,113.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.12
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,051.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,464.48
|
| Rate for Payer: Health EOS Commercial |
$3,919.56
|
| Rate for Payer: HFN Commercial |
$4,051.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,303.00
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,642.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,051.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.96
|
| Rate for Payer: Quartz Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,642.40
|
| Rate for Payer: The Alliance Commercial |
$17,616.00
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
|
DRILL BIT 4.5MM 310.48
|
Facility
|
IP
|
$1,897.00
|
|
| Hospital Charge Code |
2966212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$929.53 |
| Max. Negotiated Rate |
$1,745.24 |
| Rate for Payer: Aetna Commercial |
$1,707.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.41
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,745.24
|
| Rate for Payer: Health EOS Commercial |
$1,688.33
|
| Rate for Payer: HFN Commercial |
$1,745.24
|
| Rate for Payer: Multiplan Commercial |
$1,517.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.24
|
| Rate for Payer: Quartz Beloit One Network |
$929.53
|
| Rate for Payer: Quartz Commercial |
$1,138.20
|
| Rate for Payer: WEA Trust Commercial |
$1,043.35
|
| Rate for Payer: WPS Commercial |
$1,405.11
|
|
