|
DRILL BIT 4.5MM 310.48
|
Facility
|
OP
|
$1,897.00
|
|
| Hospital Charge Code |
2966212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$7,588.00 |
| Rate for Payer: Aetna Commercial |
$1,707.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.42
|
| Rate for Payer: Aetna Managed Medicare |
$531.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,233.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$948.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.56
|
| 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: Dean Health DHI/DHP/ASO |
$1,061.56
|
| Rate for Payer: Health EOS Commercial |
$1,688.33
|
| Rate for Payer: HFN Commercial |
$1,745.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,422.75
|
| 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 |
$1,233.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,138.20
|
| Rate for Payer: The Alliance Commercial |
$7,588.00
|
| Rate for Payer: WEA Trust Commercial |
$1,043.35
|
| Rate for Payer: WPS Commercial |
$1,405.11
|
|
|
DRILL BIT 4.5MM LONG AR-8970-45L
|
Facility
|
IP
|
$1,920.00
|
|
| Hospital Charge Code |
5803669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$940.80 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
DRILL BIT 4.5MM LONG AR-8970-45L
|
Facility
|
OP
|
$1,920.00
|
|
| Hospital Charge Code |
5803669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$7,680.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Aetna Managed Medicare |
$537.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,248.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$960.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.43
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,152.00
|
| Rate for Payer: The Alliance Commercial |
$7,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
DRILL BIT 4.5MM SPADE PILOT 214-00-007
|
Facility
|
OP
|
$3,048.00
|
|
| Hospital Charge Code |
3737515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$853.44 |
| Max. Negotiated Rate |
$12,192.00 |
| Rate for Payer: Aetna Commercial |
$2,743.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.28
|
| Rate for Payer: Aetna Managed Medicare |
$853.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,981.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,524.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,463.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.44
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,804.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,705.66
|
| Rate for Payer: Health EOS Commercial |
$2,712.72
|
| Rate for Payer: HFN Commercial |
$2,804.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,286.00
|
| Rate for Payer: Multiplan Commercial |
$2,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.52
|
| Rate for Payer: Quartz Commercial |
$1,981.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,828.80
|
| Rate for Payer: The Alliance Commercial |
$12,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,676.40
|
| Rate for Payer: WPS Commercial |
$2,257.65
|
|
|
DRILL BIT 4.5MM SPADE PILOT 214-00-007
|
Facility
|
IP
|
$3,048.00
|
|
| Hospital Charge Code |
3737515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,493.52 |
| Max. Negotiated Rate |
$2,804.16 |
| Rate for Payer: Aetna Commercial |
$2,743.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.44
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,804.16
|
| Rate for Payer: Health EOS Commercial |
$2,712.72
|
| Rate for Payer: HFN Commercial |
$2,804.16
|
| Rate for Payer: Multiplan Commercial |
$2,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.52
|
| Rate for Payer: Quartz Commercial |
$1,828.80
|
| Rate for Payer: WEA Trust Commercial |
$1,676.40
|
| Rate for Payer: WPS Commercial |
$2,257.65
|
|
|
DRILL BIT 4.5MM X12.7CM 00-2318-045-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
5349274
|
|
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 4.5MM X12.7CM 00-2318-045-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
5349274
|
|
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 4.5 QUICK COUPLING 310.44
|
Facility
|
IP
|
$1,372.00
|
|
| Hospital Charge Code |
2966210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.28 |
| Max. Negotiated Rate |
$1,262.24 |
| Rate for Payer: Aetna Commercial |
$1,234.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.16
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,262.24
|
| Rate for Payer: Health EOS Commercial |
$1,221.08
|
| Rate for Payer: HFN Commercial |
$1,262.24
|
| Rate for Payer: Multiplan Commercial |
$1,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$823.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.24
|
| Rate for Payer: Quartz Beloit One Network |
$672.28
|
| Rate for Payer: Quartz Commercial |
$823.20
|
| Rate for Payer: WEA Trust Commercial |
$754.60
|
| Rate for Payer: WPS Commercial |
$1,016.24
|
|
|
DRILL BIT 4.5 QUICK COUPLING 310.44
|
Facility
|
OP
|
$1,372.00
|
|
| Hospital Charge Code |
2966210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$5,488.00 |
| Rate for Payer: Aetna Commercial |
$1,234.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.92
|
| Rate for Payer: Aetna Managed Medicare |
$384.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$891.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.16
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,262.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$767.77
|
| Rate for Payer: Health EOS Commercial |
$1,221.08
|
| Rate for Payer: HFN Commercial |
$1,262.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.00
|
| Rate for Payer: Multiplan Commercial |
$1,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$823.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.24
|
| Rate for Payer: Quartz Beloit One Network |
$672.28
|
| Rate for Payer: Quartz Commercial |
$891.80
|
| Rate for Payer: Quartz Medicare Advantage |
$823.20
|
| Rate for Payer: The Alliance Commercial |
$5,488.00
|
| Rate for Payer: WEA Trust Commercial |
$754.60
|
| Rate for Payer: WPS Commercial |
$1,016.24
|
|
|
DRILL BIT 4.5 W/STOP
|
Facility
|
IP
|
$4,522.00
|
|
| Hospital Charge Code |
2966211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,215.78 |
| Max. Negotiated Rate |
$4,160.24 |
| Rate for Payer: Aetna Commercial |
$4,069.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,888.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.66
|
| Rate for Payer: Cash Price |
$1,356.60
|
| Rate for Payer: Cigna Commercial |
$4,160.24
|
| Rate for Payer: Health EOS Commercial |
$4,024.58
|
| Rate for Payer: HFN Commercial |
$4,160.24
|
| Rate for Payer: Multiplan Commercial |
$3,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,713.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,160.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.78
|
| Rate for Payer: Quartz Commercial |
$2,713.20
|
| Rate for Payer: WEA Trust Commercial |
$2,487.10
|
| Rate for Payer: WPS Commercial |
$3,349.45
|
|
|
DRILL BIT 4.5 W/STOP
|
Facility
|
OP
|
$4,522.00
|
|
| Hospital Charge Code |
2966211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$18,088.00 |
| Rate for Payer: Aetna Commercial |
$4,069.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,888.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,266.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,939.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,261.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,170.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.66
|
| Rate for Payer: Cash Price |
$1,356.60
|
| Rate for Payer: Cigna Commercial |
$4,160.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,530.51
|
| Rate for Payer: Health EOS Commercial |
$4,024.58
|
| Rate for Payer: HFN Commercial |
$4,160.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,391.50
|
| Rate for Payer: Multiplan Commercial |
$3,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,713.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,160.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.78
|
| Rate for Payer: Quartz Commercial |
$2,939.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,713.20
|
| Rate for Payer: The Alliance Commercial |
$18,088.00
|
| Rate for Payer: WEA Trust Commercial |
$2,487.10
|
| Rate for Payer: WPS Commercial |
$3,349.45
|
|
|
DRILL BIT 4.8MM X12.7CM 3/16 00-2318-048-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
2967405
|
|
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 4.8MM X12.7CM 3/16 00-2318-048-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
2967405
|
|
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 4.9MM AO FITTING 705252
|
Facility
|
IP
|
$3,338.00
|
|
| Hospital Charge Code |
5641644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,635.62 |
| Max. Negotiated Rate |
$3,070.96 |
| Rate for Payer: Aetna Commercial |
$3,004.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,769.14
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,070.96
|
| Rate for Payer: Health EOS Commercial |
$2,970.82
|
| Rate for Payer: HFN Commercial |
$3,070.96
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,002.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,070.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.62
|
| Rate for Payer: Quartz Commercial |
$2,002.80
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
DRILL BIT 4.9MM AO FITTING 705252
|
Facility
|
OP
|
$3,338.00
|
|
| Hospital Charge Code |
5641644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.64 |
| Max. Negotiated Rate |
$13,352.00 |
| Rate for Payer: Aetna Commercial |
$3,004.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Aetna Managed Medicare |
$934.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,169.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,669.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,602.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,769.14
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,070.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,867.94
|
| Rate for Payer: Health EOS Commercial |
$2,970.82
|
| Rate for Payer: HFN Commercial |
$3,070.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,503.50
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,002.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,070.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.62
|
| Rate for Payer: Quartz Commercial |
$2,169.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,002.80
|
| Rate for Payer: The Alliance Commercial |
$13,352.00
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
DRILL BIT 5.0MM 3-FLUTED
|
Facility
|
IP
|
$3,373.00
|
|
| Hospital Charge Code |
2966214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,652.77 |
| Max. Negotiated Rate |
$3,103.16 |
| Rate for Payer: Aetna Commercial |
$3,035.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,900.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,787.69
|
| Rate for Payer: Cash Price |
$1,011.90
|
| Rate for Payer: Cigna Commercial |
$3,103.16
|
| Rate for Payer: Health EOS Commercial |
$3,001.97
|
| Rate for Payer: HFN Commercial |
$3,103.16
|
| Rate for Payer: Multiplan Commercial |
$2,698.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,023.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,103.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,652.77
|
| Rate for Payer: Quartz Commercial |
$2,023.80
|
| Rate for Payer: WEA Trust Commercial |
$1,855.15
|
| Rate for Payer: WPS Commercial |
$2,498.38
|
|
|
DRILL BIT 5.0MM 3-FLUTED
|
Facility
|
OP
|
$3,373.00
|
|
| Hospital Charge Code |
2966214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$944.44 |
| Max. Negotiated Rate |
$13,492.00 |
| Rate for Payer: Aetna Commercial |
$3,035.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,900.78
|
| Rate for Payer: Aetna Managed Medicare |
$944.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,192.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,686.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,619.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,787.69
|
| Rate for Payer: Cash Price |
$1,011.90
|
| Rate for Payer: Cigna Commercial |
$3,103.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,887.53
|
| Rate for Payer: Health EOS Commercial |
$3,001.97
|
| Rate for Payer: HFN Commercial |
$3,103.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,529.75
|
| Rate for Payer: Multiplan Commercial |
$2,698.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,023.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,103.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,652.77
|
| Rate for Payer: Quartz Commercial |
$2,192.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,023.80
|
| Rate for Payer: The Alliance Commercial |
$13,492.00
|
| Rate for Payer: WEA Trust Commercial |
$1,855.15
|
| Rate for Payer: WPS Commercial |
$2,498.38
|
|
|
DRILL BIT 5.0 X 230MM STRYKER 1806-5000S
|
Facility
|
IP
|
$1,379.00
|
|
| Hospital Charge Code |
5611632
|
|
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 5.0 X 230MM STRYKER 1806-5000S
|
Facility
|
OP
|
$1,379.00
|
|
| Hospital Charge Code |
5611632
|
|
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 5.5MM SOLID LONG AR-8970-55L
|
Facility
|
OP
|
$1,997.00
|
|
| Hospital Charge Code |
5603784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.16 |
| Max. Negotiated Rate |
$7,988.00 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Aetna Managed Medicare |
$559.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,298.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.52
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.75
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,298.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.20
|
| Rate for Payer: The Alliance Commercial |
$7,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
DRILL BIT 5.5MM SOLID LONG AR-8970-55L
|
Facility
|
IP
|
$1,997.00
|
|
| Hospital Charge Code |
5603784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.53 |
| Max. Negotiated Rate |
$1,837.24 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,198.20
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
DRILL BIT 5.6MM CANN AO FITTING 702611
|
Facility
|
IP
|
$2,044.00
|
|
| Hospital Charge Code |
4595035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,001.56 |
| Max. Negotiated Rate |
$1,880.48 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,226.40
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
DRILL BIT 5.6MM CANN AO FITTING 702611
|
Facility
|
OP
|
$2,044.00
|
|
| Hospital Charge Code |
4595035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$8,176.00 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Aetna Managed Medicare |
$572.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,328.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,022.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$981.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.82
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.00
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,328.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,226.40
|
| Rate for Payer: The Alliance Commercial |
$8,176.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
DRILL BIT 6.5 CONICAL W STOP
|
Facility
|
OP
|
$4,188.00
|
|
| Hospital Charge Code |
2966215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,172.64 |
| Max. Negotiated Rate |
$16,752.00 |
| Rate for Payer: Aetna Commercial |
$3,769.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,601.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,172.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,722.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,094.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,010.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,219.64
|
| Rate for Payer: Cash Price |
$1,256.40
|
| Rate for Payer: Cigna Commercial |
$3,852.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,343.60
|
| Rate for Payer: Health EOS Commercial |
$3,727.32
|
| Rate for Payer: HFN Commercial |
$3,852.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,141.00
|
| Rate for Payer: Multiplan Commercial |
$3,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,512.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,852.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,052.12
|
| Rate for Payer: Quartz Commercial |
$2,722.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,512.80
|
| Rate for Payer: The Alliance Commercial |
$16,752.00
|
| Rate for Payer: WEA Trust Commercial |
$2,303.40
|
| Rate for Payer: WPS Commercial |
$3,102.05
|
|
|
DRILL BIT 6.5 CONICAL W STOP
|
Facility
|
IP
|
$4,188.00
|
|
| Hospital Charge Code |
2966215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,052.12 |
| Max. Negotiated Rate |
$3,852.96 |
| Rate for Payer: Aetna Commercial |
$3,769.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,601.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,219.64
|
| Rate for Payer: Cash Price |
$1,256.40
|
| Rate for Payer: Cigna Commercial |
$3,852.96
|
| Rate for Payer: Health EOS Commercial |
$3,727.32
|
| Rate for Payer: HFN Commercial |
$3,852.96
|
| Rate for Payer: Multiplan Commercial |
$3,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,512.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,852.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,052.12
|
| Rate for Payer: Quartz Commercial |
$2,512.80
|
| Rate for Payer: WEA Trust Commercial |
$2,303.40
|
| Rate for Payer: WPS Commercial |
$3,102.05
|
|
