|
DRILL BIT CANN 3.5MM AO FITTING 705251
|
Facility
|
OP
|
$2,666.00
|
|
| Hospital Charge Code |
6049656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.48 |
| Max. Negotiated Rate |
$10,664.00 |
| Rate for Payer: Aetna Commercial |
$2,399.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.76
|
| Rate for Payer: Aetna Managed Medicare |
$746.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.98
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,452.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.89
|
| Rate for Payer: Health EOS Commercial |
$2,372.74
|
| Rate for Payer: HFN Commercial |
$2,452.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.50
|
| Rate for Payer: Multiplan Commercial |
$2,132.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.34
|
| Rate for Payer: Quartz Commercial |
$1,732.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.60
|
| Rate for Payer: The Alliance Commercial |
$10,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,466.30
|
| Rate for Payer: WPS Commercial |
$1,974.71
|
|
|
DRILL BIT CANN 3.5MM AO FITTING 705251
|
Facility
|
IP
|
$2,666.00
|
|
| Hospital Charge Code |
6049656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,306.34 |
| Max. Negotiated Rate |
$2,452.72 |
| Rate for Payer: Aetna Commercial |
$2,399.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.98
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,372.74
|
| Rate for Payer: HFN Commercial |
$2,452.72
|
| Rate for Payer: Multiplan Commercial |
$2,132.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.34
|
| Rate for Payer: Quartz Commercial |
$1,599.60
|
| Rate for Payer: WEA Trust Commercial |
$1,466.30
|
| Rate for Payer: WPS Commercial |
$1,974.71
|
|
|
DRILL BIT CANN 4.3MM X 200MM 310.634
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
3937334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$471.96 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
DRILL BIT CANN 4.3MM X 200MM 310.634
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
3937334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Aetna Managed Medicare |
$143.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.07
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.75
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$333.45
|
| Rate for Payer: Quartz Medicare Advantage |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$2,052.00
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
DRILL BIT CANN 5.0 300MM LARGE 310.63
|
Facility
|
IP
|
$5,192.00
|
|
| Hospital Charge Code |
2966213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,544.08 |
| Max. Negotiated Rate |
$4,776.64 |
| Rate for Payer: Aetna Commercial |
$4,672.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,465.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.76
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna Commercial |
$4,776.64
|
| Rate for Payer: Health EOS Commercial |
$4,620.88
|
| Rate for Payer: HFN Commercial |
$4,776.64
|
| Rate for Payer: Multiplan Commercial |
$4,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,776.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,544.08
|
| Rate for Payer: Quartz Commercial |
$3,115.20
|
| Rate for Payer: WEA Trust Commercial |
$2,855.60
|
| Rate for Payer: WPS Commercial |
$3,845.71
|
|
|
DRILL BIT CANN 5.0 300MM LARGE 310.63
|
Facility
|
OP
|
$5,192.00
|
|
| Hospital Charge Code |
2966213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,453.76 |
| Max. Negotiated Rate |
$20,768.00 |
| Rate for Payer: Aetna Commercial |
$4,672.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,465.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,374.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,596.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,492.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.76
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna Commercial |
$4,776.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,905.44
|
| Rate for Payer: Health EOS Commercial |
$4,620.88
|
| Rate for Payer: HFN Commercial |
$4,776.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,894.00
|
| Rate for Payer: Multiplan Commercial |
$4,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,776.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,544.08
|
| Rate for Payer: Quartz Commercial |
$3,374.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,115.20
|
| Rate for Payer: The Alliance Commercial |
$20,768.00
|
| Rate for Payer: WEA Trust Commercial |
$2,855.60
|
| Rate for Payer: WPS Commercial |
$3,845.71
|
|
|
DRILL BIT CANN 5.0MM AR-8770-02
|
Facility
|
OP
|
$2,174.00
|
|
| Hospital Charge Code |
6234123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$608.72 |
| Max. Negotiated Rate |
$8,696.00 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Aetna Managed Medicare |
$608.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,413.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,043.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,216.57
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,630.50
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,413.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,304.40
|
| Rate for Payer: The Alliance Commercial |
$8,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
DRILL BIT CANN 5.0MM AR-8770-02
|
Facility
|
IP
|
$2,174.00
|
|
| Hospital Charge Code |
6234123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,065.26 |
| Max. Negotiated Rate |
$2,000.08 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,304.40
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
DRILL BIT CANN 5.0 X 200MM QUICK COUPLING 310.632
|
Facility
|
IP
|
$2,715.00
|
|
| Hospital Charge Code |
4289891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,330.35 |
| Max. Negotiated Rate |
$2,497.80 |
| Rate for Payer: Aetna Commercial |
$2,443.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.95
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,497.80
|
| Rate for Payer: Health EOS Commercial |
$2,416.35
|
| Rate for Payer: HFN Commercial |
$2,497.80
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,629.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.35
|
| Rate for Payer: Quartz Commercial |
$1,629.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.25
|
| Rate for Payer: WPS Commercial |
$2,011.00
|
|
|
DRILL BIT CANN 5.0 X 200MM QUICK COUPLING 310.632
|
Facility
|
OP
|
$2,715.00
|
|
| Hospital Charge Code |
4289891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.20 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Aetna Commercial |
$2,443.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.90
|
| Rate for Payer: Aetna Managed Medicare |
$760.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,764.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.95
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,497.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,519.31
|
| Rate for Payer: Health EOS Commercial |
$2,416.35
|
| Rate for Payer: HFN Commercial |
$2,497.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,036.25
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,629.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.35
|
| Rate for Payer: Quartz Commercial |
$1,764.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,629.00
|
| Rate for Payer: The Alliance Commercial |
$10,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.25
|
| Rate for Payer: WPS Commercial |
$2,011.00
|
|
|
DRILL BIT CANN 5.0 X 215MM LARGE QUICK COUPLING 03.333.104
|
Facility
|
OP
|
$4,396.86
|
|
| Hospital Charge Code |
6248159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,231.12 |
| Max. Negotiated Rate |
$17,587.44 |
| Rate for Payer: Aetna Commercial |
$3,957.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,781.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,231.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,857.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,198.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,110.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,330.34
|
| Rate for Payer: Cash Price |
$1,319.06
|
| Rate for Payer: Cigna Commercial |
$4,045.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,460.48
|
| Rate for Payer: Health EOS Commercial |
$3,913.21
|
| Rate for Payer: HFN Commercial |
$4,045.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,297.64
|
| Rate for Payer: Multiplan Commercial |
$3,517.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,638.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,045.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,154.46
|
| Rate for Payer: Quartz Commercial |
$2,857.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,638.12
|
| Rate for Payer: The Alliance Commercial |
$17,587.44
|
| Rate for Payer: WEA Trust Commercial |
$2,418.27
|
| Rate for Payer: WPS Commercial |
$3,256.75
|
|
|
DRILL BIT CANN 5.0 X 215MM LARGE QUICK COUPLING 03.333.104
|
Facility
|
IP
|
$4,396.86
|
|
| Hospital Charge Code |
6248159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,154.46 |
| Max. Negotiated Rate |
$4,045.11 |
| Rate for Payer: Aetna Commercial |
$3,957.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,781.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,330.34
|
| Rate for Payer: Cash Price |
$1,319.06
|
| Rate for Payer: Cigna Commercial |
$4,045.11
|
| Rate for Payer: Health EOS Commercial |
$3,913.21
|
| Rate for Payer: HFN Commercial |
$4,045.11
|
| Rate for Payer: Multiplan Commercial |
$3,517.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,638.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,045.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,154.46
|
| Rate for Payer: Quartz Commercial |
$2,638.12
|
| Rate for Payer: WEA Trust Commercial |
$2,418.27
|
| Rate for Payer: WPS Commercial |
$3,256.75
|
|
|
DRILL BIT CANN AND COUNTERSINK 1.7MM X L12MM XFO051201
|
Facility
|
OP
|
$2,627.00
|
|
| Hospital Charge Code |
5583413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$735.56 |
| Max. Negotiated Rate |
$10,508.00 |
| Rate for Payer: Aetna Commercial |
$2,364.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,259.22
|
| Rate for Payer: Aetna Managed Medicare |
$735.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,707.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,260.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,392.31
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$2,416.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,470.07
|
| Rate for Payer: Health EOS Commercial |
$2,338.03
|
| Rate for Payer: HFN Commercial |
$2,416.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,970.25
|
| Rate for Payer: Multiplan Commercial |
$2,101.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,576.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,416.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,287.23
|
| Rate for Payer: Quartz Commercial |
$1,707.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,576.20
|
| Rate for Payer: The Alliance Commercial |
$10,508.00
|
| Rate for Payer: WEA Trust Commercial |
$1,444.85
|
| Rate for Payer: WPS Commercial |
$1,945.82
|
|
|
DRILL BIT CANN AND COUNTERSINK 1.7MM X L12MM XFO051201
|
Facility
|
IP
|
$2,627.00
|
|
| Hospital Charge Code |
5583413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,287.23 |
| Max. Negotiated Rate |
$2,416.84 |
| Rate for Payer: Aetna Commercial |
$2,364.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,259.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,392.31
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$2,416.84
|
| Rate for Payer: Health EOS Commercial |
$2,338.03
|
| Rate for Payer: HFN Commercial |
$2,416.84
|
| Rate for Payer: Multiplan Commercial |
$2,101.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,576.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,416.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,287.23
|
| Rate for Payer: Quartz Commercial |
$1,576.20
|
| Rate for Payer: WEA Trust Commercial |
$1,444.85
|
| Rate for Payer: WPS Commercial |
$1,945.82
|
|
|
DRILL BIT CANN AND COUNTERSINK 2.0MM X L12MM XFO041201
|
Facility
|
IP
|
$2,318.00
|
|
| Hospital Charge Code |
5583414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,135.82 |
| Max. Negotiated Rate |
$2,132.56 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,390.80
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
DRILL BIT CANN AND COUNTERSINK 2.0MM X L12MM XFO041201
|
Facility
|
OP
|
$2,318.00
|
|
| Hospital Charge Code |
5583414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$649.04 |
| Max. Negotiated Rate |
$9,272.00 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Aetna Managed Medicare |
$649.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,506.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,159.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.15
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,738.50
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,506.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,390.80
|
| Rate for Payer: The Alliance Commercial |
$9,272.00
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
DRILL BIT CANNULATED 2.0MM AR-8610DB-30C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5384921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
DRILL BIT CANNULATED 2.0MM AR-8610DB-30C
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5384921
|
|
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 CANNULATED 3.0MM AR-8610DB-43C
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5591393
|
|
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 CANNULATED 3.0MM AR-8610DB-43C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5591393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
DRILL BIT CANNULATED 4.3MM AR-8610DB-65C
|
Facility
|
IP
|
$2,174.00
|
|
| Hospital Charge Code |
5415858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,065.26 |
| Max. Negotiated Rate |
$2,000.08 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,304.40
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
DRILL BIT CANNULATED 4.3MM AR-8610DB-65C
|
Facility
|
OP
|
$2,174.00
|
|
| Hospital Charge Code |
5415858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$608.72 |
| Max. Negotiated Rate |
$8,696.00 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Aetna Managed Medicare |
$608.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,413.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,043.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,216.57
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,630.50
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,413.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,304.40
|
| Rate for Payer: The Alliance Commercial |
$8,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
DRILL BIT D 2.0MM 299005ND
|
Facility
|
OP
|
$3,402.00
|
|
| Hospital Charge Code |
5617665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$952.56 |
| Max. Negotiated Rate |
$13,608.00 |
| Rate for Payer: Aetna Commercial |
$3,061.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,925.72
|
| Rate for Payer: Aetna Managed Medicare |
$952.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,211.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,701.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,632.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,803.06
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$3,129.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,903.76
|
| Rate for Payer: Health EOS Commercial |
$3,027.78
|
| Rate for Payer: HFN Commercial |
$3,129.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,551.50
|
| Rate for Payer: Multiplan Commercial |
$2,721.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,041.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,129.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,666.98
|
| Rate for Payer: Quartz Commercial |
$2,211.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,041.20
|
| Rate for Payer: The Alliance Commercial |
$13,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,871.10
|
| Rate for Payer: WPS Commercial |
$2,519.86
|
|
|
DRILL BIT D 2.0MM 299005ND
|
Facility
|
IP
|
$3,402.00
|
|
| Hospital Charge Code |
5617665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,666.98 |
| Max. Negotiated Rate |
$3,129.84 |
| Rate for Payer: Aetna Commercial |
$3,061.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,925.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,803.06
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$3,129.84
|
| Rate for Payer: Health EOS Commercial |
$3,027.78
|
| Rate for Payer: HFN Commercial |
$3,129.84
|
| Rate for Payer: Multiplan Commercial |
$2,721.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,041.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,129.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,666.98
|
| Rate for Payer: Quartz Commercial |
$2,041.20
|
| Rate for Payer: WEA Trust Commercial |
$1,871.10
|
| Rate for Payer: WPS Commercial |
$2,519.86
|
|
|
DRILL BIT D2.8 1910-1270S
|
Facility
|
OP
|
$3,140.00
|
|
| Hospital Charge Code |
5831820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$12,560.00 |
| Rate for Payer: Aetna Commercial |
$2,826.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,700.40
|
| Rate for Payer: Aetna Managed Medicare |
$879.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,041.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,570.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,664.20
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$2,888.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,757.14
|
| Rate for Payer: Health EOS Commercial |
$2,794.60
|
| Rate for Payer: HFN Commercial |
$2,888.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,355.00
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,884.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,888.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.60
|
| Rate for Payer: Quartz Commercial |
$2,041.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,884.00
|
| Rate for Payer: The Alliance Commercial |
$12,560.00
|
| Rate for Payer: WEA Trust Commercial |
$1,727.00
|
| Rate for Payer: WPS Commercial |
$2,325.80
|
|
