|
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
|
|
|
DRILL BIT CANN 1.7MM LONG QR 316-0514
|
Facility
|
IP
|
$3,530.00
|
|
| Hospital Charge Code |
5809999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,729.70 |
| Max. Negotiated Rate |
$3,247.60 |
| Rate for Payer: Aetna Commercial |
$3,177.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,035.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,870.90
|
| Rate for Payer: Cash Price |
$1,059.00
|
| Rate for Payer: Cigna Commercial |
$3,247.60
|
| Rate for Payer: Health EOS Commercial |
$3,141.70
|
| Rate for Payer: HFN Commercial |
$3,247.60
|
| Rate for Payer: Multiplan Commercial |
$2,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,247.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,729.70
|
| Rate for Payer: Quartz Commercial |
$2,118.00
|
| Rate for Payer: WEA Trust Commercial |
$1,941.50
|
| Rate for Payer: WPS Commercial |
$2,614.67
|
|
|
DRILL BIT CANN 1.7MM LONG QR 316-0514
|
Facility
|
OP
|
$3,530.00
|
|
| Hospital Charge Code |
5809999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$988.40 |
| Max. Negotiated Rate |
$14,120.00 |
| Rate for Payer: Aetna Commercial |
$3,177.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,035.80
|
| Rate for Payer: Aetna Managed Medicare |
$988.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,294.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,765.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,694.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,870.90
|
| Rate for Payer: Cash Price |
$1,059.00
|
| Rate for Payer: Cigna Commercial |
$3,247.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,975.39
|
| Rate for Payer: Health EOS Commercial |
$3,141.70
|
| Rate for Payer: HFN Commercial |
$3,247.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,647.50
|
| Rate for Payer: Multiplan Commercial |
$2,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,247.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,729.70
|
| Rate for Payer: Quartz Commercial |
$2,294.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,118.00
|
| Rate for Payer: The Alliance Commercial |
$14,120.00
|
| Rate for Payer: WEA Trust Commercial |
$1,941.50
|
| Rate for Payer: WPS Commercial |
$2,614.67
|
|
|
DRILL BIT CANN 1.7 X 1.32MM XFO073200
|
Facility
|
OP
|
$2,642.00
|
|
| Hospital Charge Code |
5286739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$739.76 |
| Max. Negotiated Rate |
$10,568.00 |
| Rate for Payer: Aetna Commercial |
$2,377.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,272.12
|
| Rate for Payer: Aetna Managed Medicare |
$739.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,717.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,268.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.26
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cigna Commercial |
$2,430.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,478.46
|
| Rate for Payer: Health EOS Commercial |
$2,351.38
|
| Rate for Payer: HFN Commercial |
$2,430.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,981.50
|
| Rate for Payer: Multiplan Commercial |
$2,113.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,585.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,430.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.58
|
| Rate for Payer: Quartz Commercial |
$1,717.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,585.20
|
| Rate for Payer: The Alliance Commercial |
$10,568.00
|
| Rate for Payer: WEA Trust Commercial |
$1,453.10
|
| Rate for Payer: WPS Commercial |
$1,956.93
|
|
|
DRILL BIT CANN 1.7 X 1.32MM XFO073200
|
Facility
|
IP
|
$2,642.00
|
|
| Hospital Charge Code |
5286739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,294.58 |
| Max. Negotiated Rate |
$2,430.64 |
| Rate for Payer: Aetna Commercial |
$2,377.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,272.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.26
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cigna Commercial |
$2,430.64
|
| Rate for Payer: Health EOS Commercial |
$2,351.38
|
| Rate for Payer: HFN Commercial |
$2,430.64
|
| Rate for Payer: Multiplan Commercial |
$2,113.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,585.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,430.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.58
|
| Rate for Payer: Quartz Commercial |
$1,585.20
|
| Rate for Payer: WEA Trust Commercial |
$1,453.10
|
| Rate for Payer: WPS Commercial |
$1,956.93
|
|
|
DRILL BIT CANN 1.9MM (YELLOW) IS1112
|
Facility
|
OP
|
$2,756.00
|
|
| Hospital Charge Code |
5685826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$771.68 |
| Max. Negotiated Rate |
$11,024.00 |
| Rate for Payer: Aetna Commercial |
$2,480.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,370.16
|
| Rate for Payer: Aetna Managed Medicare |
$771.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,791.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,322.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,460.68
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,535.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,542.26
|
| Rate for Payer: Health EOS Commercial |
$2,452.84
|
| Rate for Payer: HFN Commercial |
$2,535.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,067.00
|
| Rate for Payer: Multiplan Commercial |
$2,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,535.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,350.44
|
| Rate for Payer: Quartz Commercial |
$1,791.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,653.60
|
| Rate for Payer: The Alliance Commercial |
$11,024.00
|
| Rate for Payer: WEA Trust Commercial |
$1,515.80
|
| Rate for Payer: WPS Commercial |
$2,041.37
|
|
|
DRILL BIT CANN 1.9MM (YELLOW) IS1112
|
Facility
|
IP
|
$2,756.00
|
|
| Hospital Charge Code |
5685826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,350.44 |
| Max. Negotiated Rate |
$2,535.52 |
| Rate for Payer: Aetna Commercial |
$2,480.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,370.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,460.68
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,535.52
|
| Rate for Payer: Health EOS Commercial |
$2,452.84
|
| Rate for Payer: HFN Commercial |
$2,535.52
|
| Rate for Payer: Multiplan Commercial |
$2,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,535.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,350.44
|
| Rate for Payer: Quartz Commercial |
$1,653.60
|
| Rate for Payer: WEA Trust Commercial |
$1,515.80
|
| Rate for Payer: WPS Commercial |
$2,041.37
|
|
|
DRILL BIT CANN 2.0/2.4 TIGER 210-24-001
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3491511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
DRILL BIT CANN 2.0/2.4 TIGER 210-24-001
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3491511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$12,664.00 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Aetna Managed Medicare |
$886.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,771.69
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,374.50
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$2,057.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,899.60
|
| Rate for Payer: The Alliance Commercial |
$12,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
DRILL BIT CANN 2.0 X 145MM QUICK COUPLING 03.333.101
|
Facility
|
IP
|
$2,147.87
|
|
| Hospital Charge Code |
6248163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.46 |
| Max. Negotiated Rate |
$1,976.04 |
| Rate for Payer: Aetna Commercial |
$1,933.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,847.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,138.37
|
| Rate for Payer: Cash Price |
$644.36
|
| Rate for Payer: Cigna Commercial |
$1,976.04
|
| Rate for Payer: Health EOS Commercial |
$1,911.60
|
| Rate for Payer: HFN Commercial |
$1,976.04
|
| Rate for Payer: Multiplan Commercial |
$1,718.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,288.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,976.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.46
|
| Rate for Payer: Quartz Commercial |
$1,288.72
|
| Rate for Payer: WEA Trust Commercial |
$1,181.33
|
| Rate for Payer: WPS Commercial |
$1,590.93
|
|
|
DRILL BIT CANN 2.0 X 145MM QUICK COUPLING 03.333.101
|
Facility
|
OP
|
$2,147.87
|
|
| Hospital Charge Code |
6248163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$601.40 |
| Max. Negotiated Rate |
$8,591.48 |
| Rate for Payer: Aetna Commercial |
$1,933.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,847.17
|
| Rate for Payer: Aetna Managed Medicare |
$601.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,396.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,073.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,030.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,138.37
|
| Rate for Payer: Cash Price |
$644.36
|
| Rate for Payer: Cigna Commercial |
$1,976.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,201.95
|
| Rate for Payer: Health EOS Commercial |
$1,911.60
|
| Rate for Payer: HFN Commercial |
$1,976.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,610.90
|
| Rate for Payer: Multiplan Commercial |
$1,718.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,288.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,976.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.46
|
| Rate for Payer: Quartz Commercial |
$1,396.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,288.72
|
| Rate for Payer: The Alliance Commercial |
$8,591.48
|
| Rate for Payer: WEA Trust Commercial |
$1,181.33
|
| Rate for Payer: WPS Commercial |
$1,590.93
|
|
|
DRILL BIT CANN 2.1MM (GREEN) IS1113
|
Facility
|
IP
|
$2,756.00
|
|
| Hospital Charge Code |
5659624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,350.44 |
| Max. Negotiated Rate |
$2,535.52 |
| Rate for Payer: Aetna Commercial |
$2,480.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,370.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,460.68
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,535.52
|
| Rate for Payer: Health EOS Commercial |
$2,452.84
|
| Rate for Payer: HFN Commercial |
$2,535.52
|
| Rate for Payer: Multiplan Commercial |
$2,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,535.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,350.44
|
| Rate for Payer: Quartz Commercial |
$1,653.60
|
| Rate for Payer: WEA Trust Commercial |
$1,515.80
|
| Rate for Payer: WPS Commercial |
$2,041.37
|
|
|
DRILL BIT CANN 2.1MM (GREEN) IS1113
|
Facility
|
OP
|
$2,756.00
|
|
| Hospital Charge Code |
5659624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$771.68 |
| Max. Negotiated Rate |
$11,024.00 |
| Rate for Payer: Aetna Commercial |
$2,480.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,370.16
|
| Rate for Payer: Aetna Managed Medicare |
$771.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,791.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,322.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,460.68
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,535.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,542.26
|
| Rate for Payer: Health EOS Commercial |
$2,452.84
|
| Rate for Payer: HFN Commercial |
$2,535.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,067.00
|
| Rate for Payer: Multiplan Commercial |
$2,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,535.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,350.44
|
| Rate for Payer: Quartz Commercial |
$1,791.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,653.60
|
| Rate for Payer: The Alliance Commercial |
$11,024.00
|
| Rate for Payer: WEA Trust Commercial |
$1,515.80
|
| Rate for Payer: WPS Commercial |
$2,041.37
|
|
|
DRILL BIT CANN 2.4MM & PASSING WIRE AR-1594D-24
|
Facility
|
IP
|
$2,929.00
|
|
| Hospital Charge Code |
6220125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,435.21 |
| Max. Negotiated Rate |
$2,694.68 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,757.40
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
DRILL BIT CANN 2.4MM & PASSING WIRE AR-1594D-24
|
Facility
|
OP
|
$2,929.00
|
|
| Hospital Charge Code |
6220125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$820.12 |
| Max. Negotiated Rate |
$11,716.00 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Aetna Managed Medicare |
$820.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,903.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.07
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,196.75
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,903.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.40
|
| Rate for Payer: The Alliance Commercial |
$11,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
DRILL BIT CANN 2.6MM IS1114
|
Facility
|
IP
|
$1,986.00
|
|
| Hospital Charge Code |
6171785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$1,827.12 |
| Rate for Payer: Aetna Commercial |
$1,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.58
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,827.12
|
| Rate for Payer: Health EOS Commercial |
$1,767.54
|
| Rate for Payer: HFN Commercial |
$1,827.12
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.12
|
| Rate for Payer: Quartz Beloit One Network |
$973.14
|
| Rate for Payer: Quartz Commercial |
$1,191.60
|
| Rate for Payer: WEA Trust Commercial |
$1,092.30
|
| Rate for Payer: WPS Commercial |
$1,471.03
|
|
|
DRILL BIT CANN 2.6MM IS1114
|
Facility
|
OP
|
$1,986.00
|
|
| Hospital Charge Code |
6171785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.08 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$1,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.96
|
| Rate for Payer: Aetna Managed Medicare |
$556.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,290.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$993.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$953.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.58
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,827.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.37
|
| Rate for Payer: Health EOS Commercial |
$1,767.54
|
| Rate for Payer: HFN Commercial |
$1,827.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,489.50
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.12
|
| Rate for Payer: Quartz Beloit One Network |
$973.14
|
| Rate for Payer: Quartz Commercial |
$1,290.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,191.60
|
| Rate for Payer: The Alliance Commercial |
$7,944.00
|
| Rate for Payer: WEA Trust Commercial |
$1,092.30
|
| Rate for Payer: WPS Commercial |
$1,471.03
|
|
|
DRILL BIT CANN 2.7MM AO COUPLING STRYKER 702449
|
Facility
|
IP
|
$2,212.00
|
|
| Hospital Charge Code |
5415593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,083.88 |
| Max. Negotiated Rate |
$2,035.04 |
| Rate for Payer: Aetna Commercial |
$1,990.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,902.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.36
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$2,035.04
|
| Rate for Payer: Health EOS Commercial |
$1,968.68
|
| Rate for Payer: HFN Commercial |
$2,035.04
|
| Rate for Payer: Multiplan Commercial |
$1,769.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,327.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,035.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,083.88
|
| Rate for Payer: Quartz Commercial |
$1,327.20
|
| Rate for Payer: WEA Trust Commercial |
$1,216.60
|
| Rate for Payer: WPS Commercial |
$1,638.43
|
|
|
DRILL BIT CANN 2.7MM AO COUPLING STRYKER 702449
|
Facility
|
OP
|
$2,212.00
|
|
| Hospital Charge Code |
5415593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.36 |
| Max. Negotiated Rate |
$8,848.00 |
| Rate for Payer: Aetna Commercial |
$1,990.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,902.32
|
| Rate for Payer: Aetna Managed Medicare |
$619.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,437.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,106.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,061.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.36
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$2,035.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,237.84
|
| Rate for Payer: Health EOS Commercial |
$1,968.68
|
| Rate for Payer: HFN Commercial |
$2,035.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.00
|
| Rate for Payer: Multiplan Commercial |
$1,769.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,327.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,035.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,083.88
|
| Rate for Payer: Quartz Commercial |
$1,437.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,327.20
|
| Rate for Payer: The Alliance Commercial |
$8,848.00
|
| Rate for Payer: WEA Trust Commercial |
$1,216.60
|
| Rate for Payer: WPS Commercial |
$1,638.43
|
|
|
DRILL BIT CANN 3.0 X 170MM WITH CALIBRATIONS AO 705357
|
Facility
|
OP
|
$1,468.00
|
|
| Hospital Charge Code |
6166131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.04 |
| Max. Negotiated Rate |
$5,872.00 |
| Rate for Payer: Aetna Commercial |
$1,321.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.48
|
| Rate for Payer: Aetna Managed Medicare |
$411.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$954.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$734.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$704.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.04
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,350.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$821.49
|
| Rate for Payer: Health EOS Commercial |
$1,306.52
|
| Rate for Payer: HFN Commercial |
$1,350.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,101.00
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,350.56
|
| Rate for Payer: Quartz Beloit One Network |
$719.32
|
| Rate for Payer: Quartz Commercial |
$954.20
|
| Rate for Payer: Quartz Medicare Advantage |
$880.80
|
| Rate for Payer: The Alliance Commercial |
$5,872.00
|
| Rate for Payer: WEA Trust Commercial |
$807.40
|
| Rate for Payer: WPS Commercial |
$1,087.35
|
|
|
DRILL BIT CANN 3.0 X 170MM WITH CALIBRATIONS AO 705357
|
Facility
|
IP
|
$1,468.00
|
|
| Hospital Charge Code |
6166131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$719.32 |
| Max. Negotiated Rate |
$1,350.56 |
| Rate for Payer: Aetna Commercial |
$1,321.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.04
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,350.56
|
| Rate for Payer: Health EOS Commercial |
$1,306.52
|
| Rate for Payer: HFN Commercial |
$1,350.56
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,350.56
|
| Rate for Payer: Quartz Beloit One Network |
$719.32
|
| Rate for Payer: Quartz Commercial |
$880.80
|
| Rate for Payer: WEA Trust Commercial |
$807.40
|
| Rate for Payer: WPS Commercial |
$1,087.35
|
|
|
DRILL BIT CANN 3.0 X 60MM ORTHOLOC 58850030
|
Facility
|
OP
|
$1,948.00
|
|
| Hospital Charge Code |
6173852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.44 |
| Max. Negotiated Rate |
$7,792.00 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Aetna Managed Medicare |
$545.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,266.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$974.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$935.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,090.10
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,461.00
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,266.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.80
|
| Rate for Payer: The Alliance Commercial |
$7,792.00
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
DRILL BIT CANN 3.0 X 60MM ORTHOLOC 58850030
|
Facility
|
IP
|
$1,948.00
|
|
| Hospital Charge Code |
6173852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$954.52 |
| Max. Negotiated Rate |
$1,792.16 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,168.80
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
DRILL BIT CANN 3.2MM 170/140MM 310.65
|
Facility
|
OP
|
$5,121.00
|
|
| Hospital Charge Code |
3375505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,433.88 |
| Max. Negotiated Rate |
$20,484.00 |
| Rate for Payer: Aetna Commercial |
$4,608.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,404.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,328.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,458.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,714.13
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,711.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.71
|
| Rate for Payer: Health EOS Commercial |
$4,557.69
|
| Rate for Payer: HFN Commercial |
$4,711.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,840.75
|
| Rate for Payer: Multiplan Commercial |
$4,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,072.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,711.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,509.29
|
| Rate for Payer: Quartz Commercial |
$3,328.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,072.60
|
| Rate for Payer: The Alliance Commercial |
$20,484.00
|
| Rate for Payer: WEA Trust Commercial |
$2,816.55
|
| Rate for Payer: WPS Commercial |
$3,793.12
|
|
|
DRILL BIT CANN 3.2MM 170/140MM 310.65
|
Facility
|
IP
|
$5,121.00
|
|
| Hospital Charge Code |
3375505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,509.29 |
| Max. Negotiated Rate |
$4,711.32 |
| Rate for Payer: Aetna Commercial |
$4,608.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,404.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,714.13
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,711.32
|
| Rate for Payer: Health EOS Commercial |
$4,557.69
|
| Rate for Payer: HFN Commercial |
$4,711.32
|
| Rate for Payer: Multiplan Commercial |
$4,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,072.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,711.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,509.29
|
| Rate for Payer: Quartz Commercial |
$3,072.60
|
| Rate for Payer: WEA Trust Commercial |
$2,816.55
|
| Rate for Payer: WPS Commercial |
$3,793.12
|
|
