|
DRILL 4 X 38 ROUND CARBIDE #E8140LSO
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.38 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$999.65
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
DRILL 4 X 38 ROUND CARBIDE #E8140LSO
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.50 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Aetna Managed Medicare |
$466.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,082.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$833.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$799.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.36
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.56
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: NAPHCARE Commercial |
$999.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$1,082.95
|
| Rate for Payer: Quartz Medicare Advantage |
$999.65
|
| Rate for Payer: The Alliance Commercial |
$833.04
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
DRILL 4X48 DIAMOND E5240
|
Facility
|
IP
|
$1,611.00
|
|
| Hospital Charge Code |
2964915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$820.97 |
| Max. Negotiated Rate |
$1,541.40 |
| Rate for Payer: Aetna Commercial |
$1,507.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,440.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$887.98
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna Commercial |
$1,541.40
|
| Rate for Payer: Health EOS Commercial |
$1,491.14
|
| Rate for Payer: HFN Commercial |
$1,541.40
|
| Rate for Payer: Multiplan Commercial |
$1,340.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,541.40
|
| Rate for Payer: Quartz Beloit One Network |
$820.97
|
| Rate for Payer: Quartz Commercial |
$1,005.26
|
| Rate for Payer: WEA Trust Commercial |
$921.49
|
| Rate for Payer: WPS Commercial |
$1,240.95
|
|
|
DRILL 4X48 DIAMOND E5240
|
Facility
|
OP
|
$1,611.00
|
|
| Hospital Charge Code |
2964915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.12 |
| Max. Negotiated Rate |
$1,541.40 |
| Rate for Payer: Aetna Commercial |
$1,507.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,440.88
|
| Rate for Payer: Aetna Managed Medicare |
$469.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,089.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$837.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$804.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$887.98
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna Commercial |
$1,541.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$937.60
|
| Rate for Payer: Health EOS Commercial |
$1,491.14
|
| Rate for Payer: HFN Commercial |
$1,541.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,256.58
|
| Rate for Payer: Multiplan Commercial |
$1,340.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,005.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,541.40
|
| Rate for Payer: Quartz Beloit One Network |
$820.97
|
| Rate for Payer: Quartz Commercial |
$1,089.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,005.26
|
| Rate for Payer: The Alliance Commercial |
$837.72
|
| Rate for Payer: WEA Trust Commercial |
$921.49
|
| Rate for Payer: WPS Commercial |
$1,240.95
|
|
|
DRILL AND PIN SET 2001-00-000
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2967461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.00 |
| Max. Negotiated Rate |
$1,545.23 |
| Rate for Payer: Aetna Commercial |
$1,511.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,444.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.19
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,545.23
|
| Rate for Payer: Health EOS Commercial |
$1,494.84
|
| Rate for Payer: HFN Commercial |
$1,545.23
|
| Rate for Payer: Multiplan Commercial |
$1,343.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,545.23
|
| Rate for Payer: Quartz Beloit One Network |
$823.00
|
| Rate for Payer: Quartz Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$923.78
|
| Rate for Payer: WPS Commercial |
$1,244.03
|
|
|
DRILL AND PIN SET 2001-00-000
|
Facility
|
OP
|
$1,615.00
|
|
| Hospital Charge Code |
2967461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.29 |
| Max. Negotiated Rate |
$1,545.23 |
| Rate for Payer: Aetna Commercial |
$1,511.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,444.46
|
| Rate for Payer: Aetna Managed Medicare |
$470.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,091.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$806.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.19
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,545.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.93
|
| Rate for Payer: Health EOS Commercial |
$1,494.84
|
| Rate for Payer: HFN Commercial |
$1,545.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,259.70
|
| Rate for Payer: Multiplan Commercial |
$1,343.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,007.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,545.23
|
| Rate for Payer: Quartz Beloit One Network |
$823.00
|
| Rate for Payer: Quartz Commercial |
$1,091.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,007.76
|
| Rate for Payer: The Alliance Commercial |
$839.80
|
| Rate for Payer: WEA Trust Commercial |
$923.78
|
| Rate for Payer: WPS Commercial |
$1,244.03
|
|
|
DRILL BIT
|
Facility
|
OP
|
$1,525.00
|
|
| Hospital Charge Code |
2965382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.08 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$793.00
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
DRILL BIT
|
Facility
|
IP
|
$1,525.00
|
|
| Hospital Charge Code |
2965382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
DRILL BIT 0.76MM W 10MM STOP MINI 316.290
|
Facility
|
IP
|
$1,498.00
|
|
| Hospital Charge Code |
4508841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$763.38 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,402.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,433.29
|
| Rate for Payer: Health EOS Commercial |
$1,386.55
|
| Rate for Payer: HFN Commercial |
$1,433.29
|
| Rate for Payer: Multiplan Commercial |
$1,246.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.29
|
| Rate for Payer: Quartz Beloit One Network |
$763.38
|
| Rate for Payer: Quartz Commercial |
$934.75
|
| Rate for Payer: WEA Trust Commercial |
$856.86
|
| Rate for Payer: WPS Commercial |
$1,153.91
|
|
|
DRILL BIT 0.76MM W 10MM STOP MINI 316.290
|
Facility
|
OP
|
$1,498.00
|
|
| Hospital Charge Code |
4508841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.22 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,402.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.81
|
| Rate for Payer: Aetna Managed Medicare |
$436.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,012.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$747.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,433.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$871.84
|
| Rate for Payer: Health EOS Commercial |
$1,386.55
|
| Rate for Payer: HFN Commercial |
$1,433.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,168.44
|
| Rate for Payer: Multiplan Commercial |
$1,246.34
|
| Rate for Payer: NAPHCARE Commercial |
$934.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.29
|
| Rate for Payer: Quartz Beloit One Network |
$763.38
|
| Rate for Payer: Quartz Commercial |
$1,012.65
|
| Rate for Payer: Quartz Medicare Advantage |
$934.75
|
| Rate for Payer: The Alliance Commercial |
$778.96
|
| Rate for Payer: WEA Trust Commercial |
$856.86
|
| Rate for Payer: WPS Commercial |
$1,153.91
|
|
|
DRILL BIT 1.0
|
Facility
|
IP
|
$1,220.00
|
|
| Hospital Charge Code |
2966172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.71 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Aetna Commercial |
$1,141.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.46
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$1,167.30
|
| Rate for Payer: Health EOS Commercial |
$1,129.23
|
| Rate for Payer: HFN Commercial |
$1,167.30
|
| Rate for Payer: Multiplan Commercial |
$1,015.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.30
|
| Rate for Payer: Quartz Beloit One Network |
$621.71
|
| Rate for Payer: Quartz Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$697.84
|
| Rate for Payer: WPS Commercial |
$939.77
|
|
|
DRILL BIT 1.0
|
Facility
|
OP
|
$1,220.00
|
|
| Hospital Charge Code |
2966172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.26 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Aetna Commercial |
$1,141.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.17
|
| Rate for Payer: Aetna Managed Medicare |
$355.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$824.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$609.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.46
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$1,167.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.04
|
| Rate for Payer: Health EOS Commercial |
$1,129.23
|
| Rate for Payer: HFN Commercial |
$1,167.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$951.60
|
| Rate for Payer: Multiplan Commercial |
$1,015.04
|
| Rate for Payer: NAPHCARE Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.30
|
| Rate for Payer: Quartz Beloit One Network |
$621.71
|
| Rate for Payer: Quartz Commercial |
$824.72
|
| Rate for Payer: Quartz Medicare Advantage |
$761.28
|
| Rate for Payer: The Alliance Commercial |
$634.40
|
| Rate for Payer: WEA Trust Commercial |
$697.84
|
| Rate for Payer: WPS Commercial |
$939.77
|
|
|
DRILL BIT 10MM CANN TAPERED 03.037.021
|
Facility
|
OP
|
$5,063.00
|
|
| Hospital Charge Code |
5248872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,422.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,632.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,527.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.67
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.14
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,422.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.31
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
DRILL BIT 10MM CANN TAPERED 03.037.021
|
Facility
|
IP
|
$5,063.00
|
|
| Hospital Charge Code |
5248872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,580.10 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,159.31
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
DRILL BIT 1.0MM (MINI QUICK COUPLING FOR THREADED HOLE) 03.130.102
|
Facility
|
IP
|
$1,394.00
|
|
| Hospital Charge Code |
6173402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.38 |
| Max. Negotiated Rate |
$1,333.78 |
| Rate for Payer: Aetna Commercial |
$1,304.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,246.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$768.37
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$1,333.78
|
| Rate for Payer: Health EOS Commercial |
$1,290.29
|
| Rate for Payer: HFN Commercial |
$1,333.78
|
| Rate for Payer: Multiplan Commercial |
$1,159.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,333.78
|
| Rate for Payer: Quartz Beloit One Network |
$710.38
|
| Rate for Payer: Quartz Commercial |
$869.86
|
| Rate for Payer: WEA Trust Commercial |
$797.37
|
| Rate for Payer: WPS Commercial |
$1,073.80
|
|
|
DRILL BIT 1.0MM (MINI QUICK COUPLING FOR THREADED HOLE) 03.130.102
|
Facility
|
OP
|
$1,394.00
|
|
| Hospital Charge Code |
6173402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.93 |
| Max. Negotiated Rate |
$1,333.78 |
| Rate for Payer: Aetna Commercial |
$1,304.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,246.79
|
| Rate for Payer: Aetna Managed Medicare |
$405.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$942.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$724.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$695.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$768.37
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$1,333.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$811.31
|
| Rate for Payer: Health EOS Commercial |
$1,290.29
|
| Rate for Payer: HFN Commercial |
$1,333.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,087.32
|
| Rate for Payer: Multiplan Commercial |
$1,159.81
|
| Rate for Payer: NAPHCARE Commercial |
$869.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,333.78
|
| Rate for Payer: Quartz Beloit One Network |
$710.38
|
| Rate for Payer: Quartz Commercial |
$942.34
|
| Rate for Payer: Quartz Medicare Advantage |
$869.86
|
| Rate for Payer: The Alliance Commercial |
$724.88
|
| Rate for Payer: WEA Trust Commercial |
$797.37
|
| Rate for Payer: WPS Commercial |
$1,073.80
|
|
|
DRILL BIT 1.0MMX50MM MINI QC 316.396
|
Facility
|
IP
|
$893.00
|
|
| Hospital Charge Code |
4391066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.07 |
| Max. Negotiated Rate |
$854.42 |
| Rate for Payer: Aetna Commercial |
$835.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$798.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$492.22
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cigna Commercial |
$854.42
|
| Rate for Payer: Health EOS Commercial |
$826.56
|
| Rate for Payer: HFN Commercial |
$854.42
|
| Rate for Payer: Multiplan Commercial |
$742.98
|
| Rate for Payer: Preferred Network Access Commercial |
$854.42
|
| Rate for Payer: Quartz Beloit One Network |
$455.07
|
| Rate for Payer: Quartz Commercial |
$557.23
|
| Rate for Payer: WEA Trust Commercial |
$510.80
|
| Rate for Payer: WPS Commercial |
$687.88
|
|
|
DRILL BIT 1.0MMX50MM MINI QC 316.396
|
Facility
|
OP
|
$893.00
|
|
| Hospital Charge Code |
4391066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.04 |
| Max. Negotiated Rate |
$854.42 |
| Rate for Payer: Aetna Commercial |
$835.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$798.70
|
| Rate for Payer: Aetna Managed Medicare |
$260.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$603.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$464.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$445.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$492.22
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cigna Commercial |
$854.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$519.73
|
| Rate for Payer: Health EOS Commercial |
$826.56
|
| Rate for Payer: HFN Commercial |
$854.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$696.54
|
| Rate for Payer: Multiplan Commercial |
$742.98
|
| Rate for Payer: NAPHCARE Commercial |
$557.23
|
| Rate for Payer: Preferred Network Access Commercial |
$854.42
|
| Rate for Payer: Quartz Beloit One Network |
$455.07
|
| Rate for Payer: Quartz Commercial |
$603.67
|
| Rate for Payer: Quartz Medicare Advantage |
$557.23
|
| Rate for Payer: The Alliance Commercial |
$464.36
|
| Rate for Payer: WEA Trust Commercial |
$510.80
|
| Rate for Payer: WPS Commercial |
$687.88
|
|
|
DRILL BIT 1.0MM X 61MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.101
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.08 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Aetna Managed Medicare |
$391.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$698.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$670.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.63
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,047.54
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: NAPHCARE Commercial |
$838.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$907.87
|
| Rate for Payer: Quartz Medicare Advantage |
$838.03
|
| Rate for Payer: The Alliance Commercial |
$698.36
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
DRILL BIT 1.0MM X 61MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.101
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.39 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$838.03
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
DRILL BIT 11.2 CANN LRG QC 03.233.002
|
Facility
|
OP
|
$5,930.00
|
|
| Hospital Charge Code |
6202968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,726.82 |
| Max. Negotiated Rate |
$5,673.82 |
| Rate for Payer: Aetna Commercial |
$5,550.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,303.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,726.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,008.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,083.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,960.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,268.62
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$5,673.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,451.26
|
| Rate for Payer: Health EOS Commercial |
$5,488.81
|
| Rate for Payer: HFN Commercial |
$5,673.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,625.40
|
| Rate for Payer: Multiplan Commercial |
$4,933.76
|
| Rate for Payer: NAPHCARE Commercial |
$3,700.32
|
| Rate for Payer: Preferred Network Access Commercial |
$5,673.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,021.93
|
| Rate for Payer: Quartz Commercial |
$4,008.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,700.32
|
| Rate for Payer: The Alliance Commercial |
$3,083.60
|
| Rate for Payer: WEA Trust Commercial |
$3,391.96
|
| Rate for Payer: WPS Commercial |
$4,567.88
|
|
|
DRILL BIT 11.2 CANN LRG QC 03.233.002
|
Facility
|
IP
|
$5,930.00
|
|
| Hospital Charge Code |
6202968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,021.93 |
| Max. Negotiated Rate |
$5,673.82 |
| Rate for Payer: Aetna Commercial |
$5,550.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,303.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,268.62
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$5,673.82
|
| Rate for Payer: Health EOS Commercial |
$5,488.81
|
| Rate for Payer: HFN Commercial |
$5,673.82
|
| Rate for Payer: Multiplan Commercial |
$4,933.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,673.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,021.93
|
| Rate for Payer: Quartz Commercial |
$3,700.32
|
| Rate for Payer: WEA Trust Commercial |
$3,391.96
|
| Rate for Payer: WPS Commercial |
$4,567.88
|
|
|
DRILL BIT 1.1MM 310.11
|
Facility
|
IP
|
$1,424.00
|
|
| Hospital Charge Code |
2966173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$888.58
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
DRILL BIT 1.1MM 310.11
|
Facility
|
OP
|
$1,424.00
|
|
| Hospital Charge Code |
2966173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$414.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.72
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$888.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$888.58
|
| Rate for Payer: The Alliance Commercial |
$740.48
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
DRILL BIT 1.1MM 75MM 03.114.007
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
2966174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
