|
DRILL BIT 6MM/9MM CANN STEPPED 03.037.022
|
Facility
|
OP
|
$5,742.00
|
|
| Hospital Charge Code |
5178628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,607.76 |
| Max. Negotiated Rate |
$22,968.00 |
| Rate for Payer: Aetna Commercial |
$5,167.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,938.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,607.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,732.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,756.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,043.26
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Cigna Commercial |
$5,282.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,213.22
|
| Rate for Payer: Health EOS Commercial |
$5,110.38
|
| Rate for Payer: HFN Commercial |
$5,282.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,306.50
|
| Rate for Payer: Multiplan Commercial |
$4,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,445.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,282.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,813.58
|
| Rate for Payer: Quartz Commercial |
$3,732.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,445.20
|
| Rate for Payer: The Alliance Commercial |
$22,968.00
|
| Rate for Payer: WEA Trust Commercial |
$3,158.10
|
| Rate for Payer: WPS Commercial |
$4,253.10
|
|
|
DRILL BIT 6MM/9MM CANN STEPPED 03.037.022
|
Facility
|
IP
|
$5,742.00
|
|
| Hospital Charge Code |
5178628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,813.58 |
| Max. Negotiated Rate |
$5,282.64 |
| Rate for Payer: Aetna Commercial |
$5,167.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,938.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,043.26
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Cigna Commercial |
$5,282.64
|
| Rate for Payer: Health EOS Commercial |
$5,110.38
|
| Rate for Payer: HFN Commercial |
$5,282.64
|
| Rate for Payer: Multiplan Commercial |
$4,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,445.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,282.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,813.58
|
| Rate for Payer: Quartz Commercial |
$3,445.20
|
| Rate for Payer: WEA Trust Commercial |
$3,158.10
|
| Rate for Payer: WPS Commercial |
$4,253.10
|
|
|
DRILL BIT 7.3MM LARGE QC/300MM 310.495
|
Facility
|
IP
|
$5,068.00
|
|
| Hospital Charge Code |
4067879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,483.32 |
| Max. Negotiated Rate |
$4,662.56 |
| Rate for Payer: Aetna Commercial |
$4,561.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,358.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,686.04
|
| Rate for Payer: Cash Price |
$1,520.40
|
| Rate for Payer: Cigna Commercial |
$4,662.56
|
| Rate for Payer: Health EOS Commercial |
$4,510.52
|
| Rate for Payer: HFN Commercial |
$4,662.56
|
| Rate for Payer: Multiplan Commercial |
$4,054.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,040.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,662.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.32
|
| Rate for Payer: Quartz Commercial |
$3,040.80
|
| Rate for Payer: WEA Trust Commercial |
$2,787.40
|
| Rate for Payer: WPS Commercial |
$3,753.87
|
|
|
DRILL BIT 7.3MM LARGE QC/300MM 310.495
|
Facility
|
OP
|
$5,068.00
|
|
| Hospital Charge Code |
4067879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,419.04 |
| Max. Negotiated Rate |
$20,272.00 |
| Rate for Payer: Aetna Commercial |
$4,561.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,358.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,419.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,294.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,534.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,432.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,686.04
|
| Rate for Payer: Cash Price |
$1,520.40
|
| Rate for Payer: Cigna Commercial |
$4,662.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,836.05
|
| Rate for Payer: Health EOS Commercial |
$4,510.52
|
| Rate for Payer: HFN Commercial |
$4,662.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,801.00
|
| Rate for Payer: Multiplan Commercial |
$4,054.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,040.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,662.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.32
|
| Rate for Payer: Quartz Commercial |
$3,294.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,040.80
|
| Rate for Payer: The Alliance Commercial |
$20,272.00
|
| Rate for Payer: WEA Trust Commercial |
$2,787.40
|
| Rate for Payer: WPS Commercial |
$3,753.87
|
|
|
DRILL BIT 7.4x200MM SYNTHES
|
Facility
|
OP
|
$2,402.00
|
|
| Hospital Charge Code |
2966216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.56 |
| Max. Negotiated Rate |
$9,608.00 |
| Rate for Payer: Aetna Commercial |
$2,161.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,065.72
|
| Rate for Payer: Aetna Managed Medicare |
$672.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,561.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.06
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,209.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,344.16
|
| Rate for Payer: Health EOS Commercial |
$2,137.78
|
| Rate for Payer: HFN Commercial |
$2,209.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,801.50
|
| Rate for Payer: Multiplan Commercial |
$1,921.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,441.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.98
|
| Rate for Payer: Quartz Commercial |
$1,561.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,441.20
|
| Rate for Payer: The Alliance Commercial |
$9,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,321.10
|
| Rate for Payer: WPS Commercial |
$1,779.16
|
|
|
DRILL BIT 7.4x200MM SYNTHES
|
Facility
|
IP
|
$2,402.00
|
|
| Hospital Charge Code |
2966216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,176.98 |
| Max. Negotiated Rate |
$2,209.84 |
| Rate for Payer: Aetna Commercial |
$2,161.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,065.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.06
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,209.84
|
| Rate for Payer: Health EOS Commercial |
$2,137.78
|
| Rate for Payer: HFN Commercial |
$2,209.84
|
| Rate for Payer: Multiplan Commercial |
$1,921.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,441.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.98
|
| Rate for Payer: Quartz Commercial |
$1,441.20
|
| Rate for Payer: WEA Trust Commercial |
$1,321.10
|
| Rate for Payer: WPS Commercial |
$1,779.16
|
|
|
DRILL BIT .76 MINI W/ 14MM STOP 316.294
|
Facility
|
IP
|
$2,245.00
|
|
| Hospital Charge Code |
2966171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,100.05 |
| Max. Negotiated Rate |
$2,065.40 |
| Rate for Payer: Aetna Commercial |
$2,020.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,930.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,189.85
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$2,065.40
|
| Rate for Payer: Health EOS Commercial |
$1,998.05
|
| Rate for Payer: HFN Commercial |
$2,065.40
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,347.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,065.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,100.05
|
| Rate for Payer: Quartz Commercial |
$1,347.00
|
| Rate for Payer: WEA Trust Commercial |
$1,234.75
|
| Rate for Payer: WPS Commercial |
$1,662.87
|
|
|
DRILL BIT .76 MINI W/ 14MM STOP 316.294
|
Facility
|
OP
|
$2,245.00
|
|
| Hospital Charge Code |
2966171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.60 |
| Max. Negotiated Rate |
$8,980.00 |
| Rate for Payer: Aetna Commercial |
$2,020.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,930.70
|
| Rate for Payer: Aetna Managed Medicare |
$628.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,459.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,077.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,189.85
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$2,065.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,256.30
|
| Rate for Payer: Health EOS Commercial |
$1,998.05
|
| Rate for Payer: HFN Commercial |
$2,065.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,683.75
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,347.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,065.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,100.05
|
| Rate for Payer: Quartz Commercial |
$1,459.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,347.00
|
| Rate for Payer: The Alliance Commercial |
$8,980.00
|
| Rate for Payer: WEA Trust Commercial |
$1,234.75
|
| Rate for Payer: WPS Commercial |
$1,662.87
|
|
|
DRILL BIT AO 4.2 X 180MM 1806-4270S
|
Facility
|
OP
|
$2,028.00
|
|
| Hospital Charge Code |
3072446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$8,112.00 |
| Rate for Payer: Aetna Commercial |
$1,825.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.08
|
| Rate for Payer: Aetna Managed Medicare |
$567.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,318.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,014.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$973.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.84
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$1,865.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,134.87
|
| Rate for Payer: Health EOS Commercial |
$1,804.92
|
| Rate for Payer: HFN Commercial |
$1,865.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,521.00
|
| Rate for Payer: Multiplan Commercial |
$1,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,865.76
|
| Rate for Payer: Quartz Beloit One Network |
$993.72
|
| Rate for Payer: Quartz Commercial |
$1,318.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,216.80
|
| Rate for Payer: The Alliance Commercial |
$8,112.00
|
| Rate for Payer: WEA Trust Commercial |
$1,115.40
|
| Rate for Payer: WPS Commercial |
$1,502.14
|
|
|
DRILL BIT AO 4.2 X 180MM 1806-4270S
|
Facility
|
IP
|
$2,028.00
|
|
| Hospital Charge Code |
3072446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,865.76 |
| Rate for Payer: Aetna Commercial |
$1,825.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.84
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$1,865.76
|
| Rate for Payer: Health EOS Commercial |
$1,804.92
|
| Rate for Payer: HFN Commercial |
$1,865.76
|
| Rate for Payer: Multiplan Commercial |
$1,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,865.76
|
| Rate for Payer: Quartz Beloit One Network |
$993.72
|
| Rate for Payer: Quartz Commercial |
$1,216.80
|
| Rate for Payer: WEA Trust Commercial |
$1,115.40
|
| Rate for Payer: WPS Commercial |
$1,502.14
|
|
|
DRILL BIT #ATF-032
|
Facility
|
IP
|
$1,153.00
|
|
| Hospital Charge Code |
2964137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$1,060.76 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$691.80
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
DRILL BIT #ATF-032
|
Facility
|
OP
|
$1,153.00
|
|
| Hospital Charge Code |
2964137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.84 |
| Max. Negotiated Rate |
$4,612.00 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Aetna Managed Medicare |
$322.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.22
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.75
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$749.45
|
| Rate for Payer: Quartz Medicare Advantage |
$691.80
|
| Rate for Payer: The Alliance Commercial |
$4,612.00
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 20MM AR-5025TDC
|
Facility
|
OP
|
$1,740.00
|
|
| Hospital Charge Code |
6220123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,496.40
|
| Rate for Payer: Aetna Managed Medicare |
$487.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,131.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$870.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$835.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,600.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.70
|
| Rate for Payer: Health EOS Commercial |
$1,548.60
|
| Rate for Payer: HFN Commercial |
$1,600.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,305.00
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,600.80
|
| Rate for Payer: Quartz Beloit One Network |
$852.60
|
| Rate for Payer: Quartz Commercial |
$1,131.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,044.00
|
| Rate for Payer: The Alliance Commercial |
$6,960.00
|
| Rate for Payer: WEA Trust Commercial |
$957.00
|
| Rate for Payer: WPS Commercial |
$1,288.82
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 20MM AR-5025TDC
|
Facility
|
IP
|
$1,740.00
|
|
| Hospital Charge Code |
6220123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.60 |
| Max. Negotiated Rate |
$1,600.80 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,496.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,600.80
|
| Rate for Payer: Health EOS Commercial |
$1,548.60
|
| Rate for Payer: HFN Commercial |
$1,600.80
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,600.80
|
| Rate for Payer: Quartz Beloit One Network |
$852.60
|
| Rate for Payer: Quartz Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$957.00
|
| Rate for Payer: WPS Commercial |
$1,288.82
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 22MM AR-5025TDC-22
|
Facility
|
IP
|
$1,723.00
|
|
| Hospital Charge Code |
6177773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.27 |
| Max. Negotiated Rate |
$1,585.16 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,033.80
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 22MM AR-5025TDC-22
|
Facility
|
OP
|
$1,723.00
|
|
| Hospital Charge Code |
6177773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.44 |
| Max. Negotiated Rate |
$6,892.00 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$482.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,119.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$861.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.19
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,292.25
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,119.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.80
|
| Rate for Payer: The Alliance Commercial |
$6,892.00
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
DRILL BIT BIO-SUTURE TAK AR-1250LT
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
DRILL BIT BIO-SUTURE TAK AR-1250LT
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
DRILL BIT CANN 10.2MM X 251MM 03.168.005
|
Facility
|
IP
|
$3,336.00
|
|
| Hospital Charge Code |
6178978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,634.64 |
| Max. Negotiated Rate |
$3,069.12 |
| Rate for Payer: Aetna Commercial |
$3,002.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,868.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,768.08
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,069.12
|
| Rate for Payer: Health EOS Commercial |
$2,969.04
|
| Rate for Payer: HFN Commercial |
$3,069.12
|
| Rate for Payer: Multiplan Commercial |
$2,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,069.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.64
|
| Rate for Payer: Quartz Commercial |
$2,001.60
|
| Rate for Payer: WEA Trust Commercial |
$1,834.80
|
| Rate for Payer: WPS Commercial |
$2,470.98
|
|
|
DRILL BIT CANN 10.2MM X 251MM 03.168.005
|
Facility
|
OP
|
$3,336.00
|
|
| Hospital Charge Code |
6178978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.08 |
| Max. Negotiated Rate |
$13,344.00 |
| Rate for Payer: Aetna Commercial |
$3,002.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,868.96
|
| Rate for Payer: Aetna Managed Medicare |
$934.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,168.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,668.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,601.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,768.08
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,069.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,866.83
|
| Rate for Payer: Health EOS Commercial |
$2,969.04
|
| Rate for Payer: HFN Commercial |
$3,069.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,502.00
|
| Rate for Payer: Multiplan Commercial |
$2,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,069.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.64
|
| Rate for Payer: Quartz Commercial |
$2,168.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,001.60
|
| Rate for Payer: The Alliance Commercial |
$13,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,834.80
|
| Rate for Payer: WPS Commercial |
$2,470.98
|
|
|
DRILL BIT CANN 14MM FLEXIBLE 03.033.004
|
Facility
|
OP
|
$6,143.00
|
|
| Hospital Charge Code |
6182648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,720.04 |
| Max. Negotiated Rate |
$24,572.00 |
| Rate for Payer: Aetna Commercial |
$5,528.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,282.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,720.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,992.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,071.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,948.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,255.79
|
| Rate for Payer: Cash Price |
$1,842.90
|
| Rate for Payer: Cigna Commercial |
$5,651.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,437.62
|
| Rate for Payer: Health EOS Commercial |
$5,467.27
|
| Rate for Payer: HFN Commercial |
$5,651.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,607.25
|
| Rate for Payer: Multiplan Commercial |
$4,914.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,685.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,651.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,010.07
|
| Rate for Payer: Quartz Commercial |
$3,992.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,685.80
|
| Rate for Payer: The Alliance Commercial |
$24,572.00
|
| Rate for Payer: WEA Trust Commercial |
$3,378.65
|
| Rate for Payer: WPS Commercial |
$4,550.12
|
|
|
DRILL BIT CANN 14MM FLEXIBLE 03.033.004
|
Facility
|
IP
|
$6,143.00
|
|
| Hospital Charge Code |
6182648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,010.07 |
| Max. Negotiated Rate |
$5,651.56 |
| Rate for Payer: Aetna Commercial |
$5,528.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,282.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,255.79
|
| Rate for Payer: Cash Price |
$1,842.90
|
| Rate for Payer: Cigna Commercial |
$5,651.56
|
| Rate for Payer: Health EOS Commercial |
$5,467.27
|
| Rate for Payer: HFN Commercial |
$5,651.56
|
| Rate for Payer: Multiplan Commercial |
$4,914.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,685.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,651.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,010.07
|
| Rate for Payer: Quartz Commercial |
$3,685.80
|
| Rate for Payer: WEA Trust Commercial |
$3,378.65
|
| Rate for Payer: WPS Commercial |
$4,550.12
|
|
|
DRILL BIT CANN 1.7MM AO 45-20005S
|
Facility
|
OP
|
$1,346.00
|
|
| Hospital Charge Code |
5767633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.88 |
| Max. Negotiated Rate |
$5,384.00 |
| Rate for Payer: Aetna Commercial |
$1,211.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.56
|
| Rate for Payer: Aetna Managed Medicare |
$376.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.38
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,238.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.22
|
| Rate for Payer: Health EOS Commercial |
$1,197.94
|
| Rate for Payer: HFN Commercial |
$1,238.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,009.50
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$807.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.32
|
| Rate for Payer: Quartz Beloit One Network |
$659.54
|
| Rate for Payer: Quartz Commercial |
$874.90
|
| Rate for Payer: Quartz Medicare Advantage |
$807.60
|
| Rate for Payer: The Alliance Commercial |
$5,384.00
|
| Rate for Payer: WEA Trust Commercial |
$740.30
|
| Rate for Payer: WPS Commercial |
$996.98
|
|
|
DRILL BIT CANN 1.7MM AO 45-20005S
|
Facility
|
IP
|
$1,346.00
|
|
| Hospital Charge Code |
5767633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.54 |
| Max. Negotiated Rate |
$1,238.32 |
| Rate for Payer: Aetna Commercial |
$1,211.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.38
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,238.32
|
| Rate for Payer: Health EOS Commercial |
$1,197.94
|
| Rate for Payer: HFN Commercial |
$1,238.32
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$807.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.32
|
| Rate for Payer: Quartz Beloit One Network |
$659.54
|
| Rate for Payer: Quartz Commercial |
$807.60
|
| Rate for Payer: WEA Trust Commercial |
$740.30
|
| Rate for Payer: WPS Commercial |
$996.98
|
|
|
DRILL BIT CANN 1.7MM AR-8737-17
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5415097
|
|
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
|
|
