|
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
|
|
|
DRILL BIT DHS/DCS 8.0MM TRIPLE REAMER 338.10
|
Facility
|
IP
|
$4,515.00
|
|
| Hospital Charge Code |
5178633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,212.35 |
| Max. Negotiated Rate |
$4,153.80 |
| Rate for Payer: Aetna Commercial |
$4,063.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,882.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,392.95
|
| Rate for Payer: Cash Price |
$1,354.50
|
| Rate for Payer: Cigna Commercial |
$4,153.80
|
| Rate for Payer: Health EOS Commercial |
$4,018.35
|
| Rate for Payer: HFN Commercial |
$4,153.80
|
| Rate for Payer: Multiplan Commercial |
$3,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,709.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,153.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,212.35
|
| Rate for Payer: Quartz Commercial |
$2,709.00
|
| Rate for Payer: WEA Trust Commercial |
$2,483.25
|
| Rate for Payer: WPS Commercial |
$3,344.26
|
|
|
DRILL BIT DHS/DCS 8.0MM TRIPLE REAMER 338.10
|
Facility
|
OP
|
$4,515.00
|
|
| Hospital Charge Code |
5178633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,264.20 |
| Max. Negotiated Rate |
$18,060.00 |
| Rate for Payer: Aetna Commercial |
$4,063.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,882.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,264.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,934.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,257.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,167.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,392.95
|
| Rate for Payer: Cash Price |
$1,354.50
|
| Rate for Payer: Cigna Commercial |
$4,153.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,526.59
|
| Rate for Payer: Health EOS Commercial |
$4,018.35
|
| Rate for Payer: HFN Commercial |
$4,153.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,386.25
|
| Rate for Payer: Multiplan Commercial |
$3,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,709.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,153.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,212.35
|
| Rate for Payer: Quartz Commercial |
$2,934.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,709.00
|
| Rate for Payer: The Alliance Commercial |
$18,060.00
|
| Rate for Payer: WEA Trust Commercial |
$2,483.25
|
| Rate for Payer: WPS Commercial |
$3,344.26
|
|
|
DRILL BIT FLEXIBLE 12MM LONG 03.043.016
|
Facility
|
IP
|
$6,145.00
|
|
| Hospital Charge Code |
6180621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,011.05 |
| Max. Negotiated Rate |
$5,653.40 |
| Rate for Payer: Aetna Commercial |
$5,530.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,284.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,256.85
|
| Rate for Payer: Cash Price |
$1,843.50
|
| Rate for Payer: Cigna Commercial |
$5,653.40
|
| Rate for Payer: Health EOS Commercial |
$5,469.05
|
| Rate for Payer: HFN Commercial |
$5,653.40
|
| Rate for Payer: Multiplan Commercial |
$4,916.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,687.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,653.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,011.05
|
| Rate for Payer: Quartz Commercial |
$3,687.00
|
| Rate for Payer: WEA Trust Commercial |
$3,379.75
|
| Rate for Payer: WPS Commercial |
$4,551.60
|
|
|
DRILL BIT FLEXIBLE 12MM LONG 03.043.016
|
Facility
|
OP
|
$6,145.00
|
|
| Hospital Charge Code |
6180621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,720.60 |
| Max. Negotiated Rate |
$24,580.00 |
| Rate for Payer: Aetna Commercial |
$5,530.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,284.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,720.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,994.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,072.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,949.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,256.85
|
| Rate for Payer: Cash Price |
$1,843.50
|
| Rate for Payer: Cigna Commercial |
$5,653.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,438.74
|
| Rate for Payer: Health EOS Commercial |
$5,469.05
|
| Rate for Payer: HFN Commercial |
$5,653.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,608.75
|
| Rate for Payer: Multiplan Commercial |
$4,916.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,687.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,653.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,011.05
|
| Rate for Payer: Quartz Commercial |
$3,994.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,687.00
|
| Rate for Payer: The Alliance Commercial |
$24,580.00
|
| Rate for Payer: WEA Trust Commercial |
$3,379.75
|
| Rate for Payer: WPS Commercial |
$4,551.60
|
|
|
DRILL BIT FOR 3.5MM SWIVELOCK AR-2325D
|
Facility
|
IP
|
$1,810.00
|
|
| Hospital Charge Code |
5591322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.90 |
| Max. Negotiated Rate |
$1,665.20 |
| Rate for Payer: Aetna Commercial |
$1,629.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.30
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$1,665.20
|
| Rate for Payer: Health EOS Commercial |
$1,610.90
|
| Rate for Payer: HFN Commercial |
$1,665.20
|
| Rate for Payer: Multiplan Commercial |
$1,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.20
|
| Rate for Payer: Quartz Beloit One Network |
$886.90
|
| Rate for Payer: Quartz Commercial |
$1,086.00
|
| Rate for Payer: WEA Trust Commercial |
$995.50
|
| Rate for Payer: WPS Commercial |
$1,340.67
|
|
|
DRILL BIT FOR 3.5MM SWIVELOCK AR-2325D
|
Facility
|
OP
|
$1,810.00
|
|
| Hospital Charge Code |
5591322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.80 |
| Max. Negotiated Rate |
$7,240.00 |
| Rate for Payer: Aetna Commercial |
$1,629.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.60
|
| Rate for Payer: Aetna Managed Medicare |
$506.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,176.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$905.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.30
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$1,665.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.88
|
| Rate for Payer: Health EOS Commercial |
$1,610.90
|
| Rate for Payer: HFN Commercial |
$1,665.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.50
|
| Rate for Payer: Multiplan Commercial |
$1,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.20
|
| Rate for Payer: Quartz Beloit One Network |
$886.90
|
| Rate for Payer: Quartz Commercial |
$1,176.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,086.00
|
| Rate for Payer: The Alliance Commercial |
$7,240.00
|
| Rate for Payer: WEA Trust Commercial |
$995.50
|
| Rate for Payer: WPS Commercial |
$1,340.67
|
|
|
DRILL BIT GAMMA 4.2 X 300MM 1320-3042S
|
Facility
|
IP
|
$2,029.00
|
|
| Hospital Charge Code |
3785550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.21 |
| Max. Negotiated Rate |
$1,866.68 |
| Rate for Payer: Aetna Commercial |
$1,826.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,075.37
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,866.68
|
| Rate for Payer: Health EOS Commercial |
$1,805.81
|
| Rate for Payer: HFN Commercial |
$1,866.68
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,217.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.68
|
| Rate for Payer: Quartz Beloit One Network |
$994.21
|
| Rate for Payer: Quartz Commercial |
$1,217.40
|
| Rate for Payer: WEA Trust Commercial |
$1,115.95
|
| Rate for Payer: WPS Commercial |
$1,502.88
|
|
|
DRILL BIT GAMMA 4.2 X 300MM 1320-3042S
|
Facility
|
OP
|
$2,029.00
|
|
| Hospital Charge Code |
3785550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.12 |
| Max. Negotiated Rate |
$8,116.00 |
| Rate for Payer: Aetna Commercial |
$1,826.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.94
|
| Rate for Payer: Aetna Managed Medicare |
$568.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,318.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,014.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$973.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,075.37
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,866.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,135.43
|
| Rate for Payer: Health EOS Commercial |
$1,805.81
|
| Rate for Payer: HFN Commercial |
$1,866.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,521.75
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,217.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.68
|
| Rate for Payer: Quartz Beloit One Network |
$994.21
|
| Rate for Payer: Quartz Commercial |
$1,318.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,217.40
|
| Rate for Payer: The Alliance Commercial |
$8,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,115.95
|
| Rate for Payer: WPS Commercial |
$1,502.88
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 4MM STOP 03.503.244
|
Facility
|
OP
|
$1,299.00
|
|
| Hospital Charge Code |
5264681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.72 |
| Max. Negotiated Rate |
$5,196.00 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.14
|
| Rate for Payer: Aetna Managed Medicare |
$363.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$844.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.47
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,195.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.92
|
| Rate for Payer: Health EOS Commercial |
$1,156.11
|
| Rate for Payer: HFN Commercial |
$1,195.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$974.25
|
| Rate for Payer: Multiplan Commercial |
$1,039.20
|
| Rate for Payer: NAPHCARE Commercial |
$779.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.08
|
| Rate for Payer: Quartz Beloit One Network |
$636.51
|
| Rate for Payer: Quartz Commercial |
$844.35
|
| Rate for Payer: Quartz Medicare Advantage |
$779.40
|
| Rate for Payer: The Alliance Commercial |
$5,196.00
|
| Rate for Payer: WEA Trust Commercial |
$714.45
|
| Rate for Payer: WPS Commercial |
$962.17
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 4MM STOP 03.503.244
|
Facility
|
IP
|
$1,299.00
|
|
| Hospital Charge Code |
5264681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.51 |
| Max. Negotiated Rate |
$1,195.08 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.47
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,195.08
|
| Rate for Payer: Health EOS Commercial |
$1,156.11
|
| Rate for Payer: HFN Commercial |
$1,195.08
|
| Rate for Payer: Multiplan Commercial |
$1,039.20
|
| Rate for Payer: NAPHCARE Commercial |
$779.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.08
|
| Rate for Payer: Quartz Beloit One Network |
$636.51
|
| Rate for Payer: Quartz Commercial |
$779.40
|
| Rate for Payer: WEA Trust Commercial |
$714.45
|
| Rate for Payer: WPS Commercial |
$962.17
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 6MM STOP 03.503.246
|
Facility
|
OP
|
$1,299.00
|
|
| Hospital Charge Code |
5264664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.72 |
| Max. Negotiated Rate |
$5,196.00 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.14
|
| Rate for Payer: Aetna Managed Medicare |
$363.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$844.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.47
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,195.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.92
|
| Rate for Payer: Health EOS Commercial |
$1,156.11
|
| Rate for Payer: HFN Commercial |
$1,195.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$974.25
|
| Rate for Payer: Multiplan Commercial |
$1,039.20
|
| Rate for Payer: NAPHCARE Commercial |
$779.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.08
|
| Rate for Payer: Quartz Beloit One Network |
$636.51
|
| Rate for Payer: Quartz Commercial |
$844.35
|
| Rate for Payer: Quartz Medicare Advantage |
$779.40
|
| Rate for Payer: The Alliance Commercial |
$5,196.00
|
| Rate for Payer: WEA Trust Commercial |
$714.45
|
| Rate for Payer: WPS Commercial |
$962.17
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 6MM STOP 03.503.246
|
Facility
|
IP
|
$1,299.00
|
|
| Hospital Charge Code |
5264664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.51 |
| Max. Negotiated Rate |
$1,195.08 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.47
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,195.08
|
| Rate for Payer: Health EOS Commercial |
$1,156.11
|
| Rate for Payer: HFN Commercial |
$1,195.08
|
| Rate for Payer: Multiplan Commercial |
$1,039.20
|
| Rate for Payer: NAPHCARE Commercial |
$779.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.08
|
| Rate for Payer: Quartz Beloit One Network |
$636.51
|
| Rate for Payer: Quartz Commercial |
$779.40
|
| Rate for Payer: WEA Trust Commercial |
$714.45
|
| Rate for Payer: WPS Commercial |
$962.17
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 8MM STOP 03.503.248
|
Facility
|
OP
|
$1,299.00
|
|
| Hospital Charge Code |
5306788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.72 |
| Max. Negotiated Rate |
$5,196.00 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.14
|
| Rate for Payer: Aetna Managed Medicare |
$363.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$844.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.47
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,195.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.92
|
| Rate for Payer: Health EOS Commercial |
$1,156.11
|
| Rate for Payer: HFN Commercial |
$1,195.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$974.25
|
| Rate for Payer: Multiplan Commercial |
$1,039.20
|
| Rate for Payer: NAPHCARE Commercial |
$779.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.08
|
| Rate for Payer: Quartz Beloit One Network |
$636.51
|
| Rate for Payer: Quartz Commercial |
$844.35
|
| Rate for Payer: Quartz Medicare Advantage |
$779.40
|
| Rate for Payer: The Alliance Commercial |
$5,196.00
|
| Rate for Payer: WEA Trust Commercial |
$714.45
|
| Rate for Payer: WPS Commercial |
$962.17
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 8MM STOP 03.503.248
|
Facility
|
IP
|
$1,299.00
|
|
| Hospital Charge Code |
5306788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.51 |
| Max. Negotiated Rate |
$1,195.08 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.47
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,195.08
|
| Rate for Payer: Health EOS Commercial |
$1,156.11
|
| Rate for Payer: HFN Commercial |
$1,195.08
|
| Rate for Payer: Multiplan Commercial |
$1,039.20
|
| Rate for Payer: NAPHCARE Commercial |
$779.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.08
|
| Rate for Payer: Quartz Beloit One Network |
$636.51
|
| Rate for Payer: Quartz Commercial |
$779.40
|
| Rate for Payer: WEA Trust Commercial |
$714.45
|
| Rate for Payer: WPS Commercial |
$962.17
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 125MM CALIBRATED 03.503.476
|
Facility
|
IP
|
$3,283.00
|
|
| Hospital Charge Code |
5831675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,608.67 |
| Max. Negotiated Rate |
$3,020.36 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$1,969.80
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 125MM CALIBRATED 03.503.476
|
Facility
|
OP
|
$3,283.00
|
|
| Hospital Charge Code |
5831675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$13,132.00 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Aetna Managed Medicare |
$919.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,133.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.17
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.25
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$2,133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.80
|
| Rate for Payer: The Alliance Commercial |
$13,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 50MM WITH 6MM STOP 03.503.406
|
Facility
|
OP
|
$2,649.00
|
|
| Hospital Charge Code |
4038110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$741.72 |
| Max. Negotiated Rate |
$10,596.00 |
| Rate for Payer: Aetna Commercial |
$2,384.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,278.14
|
| Rate for Payer: Aetna Managed Medicare |
$741.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,721.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,324.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,271.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.97
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cigna Commercial |
$2,437.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,482.38
|
| Rate for Payer: Health EOS Commercial |
$2,357.61
|
| Rate for Payer: HFN Commercial |
$2,437.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,986.75
|
| Rate for Payer: Multiplan Commercial |
$2,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,589.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,437.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,298.01
|
| Rate for Payer: Quartz Commercial |
$1,721.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,589.40
|
| Rate for Payer: The Alliance Commercial |
$10,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,456.95
|
| Rate for Payer: WPS Commercial |
$1,962.11
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 50MM WITH 6MM STOP 03.503.406
|
Facility
|
IP
|
$2,649.00
|
|
| Hospital Charge Code |
4038110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,298.01 |
| Max. Negotiated Rate |
$2,437.08 |
| Rate for Payer: Aetna Commercial |
$2,384.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,278.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.97
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cigna Commercial |
$2,437.08
|
| Rate for Payer: Health EOS Commercial |
$2,357.61
|
| Rate for Payer: HFN Commercial |
$2,437.08
|
| Rate for Payer: Multiplan Commercial |
$2,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,589.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,437.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,298.01
|
| Rate for Payer: Quartz Commercial |
$1,589.40
|
| Rate for Payer: WEA Trust Commercial |
$1,456.95
|
| Rate for Payer: WPS Commercial |
$1,962.11
|
|
|
DRILL BIT J-LATCH MATRIX 1.8MM X 125MM 03.503.477
|
Facility
|
IP
|
$3,283.00
|
|
| Hospital Charge Code |
5831676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,608.67 |
| Max. Negotiated Rate |
$3,020.36 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$1,969.80
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
DRILL BIT J-LATCH MATRIX 1.8MM X 125MM 03.503.477
|
Facility
|
OP
|
$3,283.00
|
|
| Hospital Charge Code |
5831676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$13,132.00 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Aetna Managed Medicare |
$919.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,133.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.17
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.25
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$2,133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.80
|
| Rate for Payer: The Alliance Commercial |
$13,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
DRILL BIT LONG ACUTRAK 2 AT2-L2525
|
Facility
|
IP
|
$3,149.00
|
|
| Hospital Charge Code |
2964136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,543.01 |
| Max. Negotiated Rate |
$2,897.08 |
| Rate for Payer: Aetna Commercial |
$2,834.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,708.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,668.97
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$2,897.08
|
| Rate for Payer: Health EOS Commercial |
$2,802.61
|
| Rate for Payer: HFN Commercial |
$2,897.08
|
| Rate for Payer: Multiplan Commercial |
$2,519.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,543.01
|
| Rate for Payer: Quartz Commercial |
$1,889.40
|
| Rate for Payer: WEA Trust Commercial |
$1,731.95
|
| Rate for Payer: WPS Commercial |
$2,332.46
|
|
|
DRILL BIT LONG ACUTRAK 2 AT2-L2525
|
Facility
|
OP
|
$3,149.00
|
|
| Hospital Charge Code |
2964136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.72 |
| Max. Negotiated Rate |
$12,596.00 |
| Rate for Payer: Aetna Commercial |
$2,834.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,708.14
|
| Rate for Payer: Aetna Managed Medicare |
$881.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,046.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,574.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,511.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,668.97
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$2,897.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,762.18
|
| Rate for Payer: Health EOS Commercial |
$2,802.61
|
| Rate for Payer: HFN Commercial |
$2,897.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,361.75
|
| Rate for Payer: Multiplan Commercial |
$2,519.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,543.01
|
| Rate for Payer: Quartz Commercial |
$2,046.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,889.40
|
| Rate for Payer: The Alliance Commercial |
$12,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,731.95
|
| Rate for Payer: WPS Commercial |
$2,332.46
|
|
|
DRILL BIT MATRIX 1.25MM 03.503.121
|
Facility
|
OP
|
$1,466.00
|
|
| Hospital Charge Code |
5298652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.48 |
| Max. Negotiated Rate |
$5,864.00 |
| Rate for Payer: Aetna Commercial |
$1,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Aetna Managed Medicare |
$410.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$952.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$703.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.98
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,348.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.37
|
| Rate for Payer: Health EOS Commercial |
$1,304.74
|
| Rate for Payer: HFN Commercial |
$1,348.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,099.50
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.72
|
| Rate for Payer: Quartz Beloit One Network |
$718.34
|
| Rate for Payer: Quartz Commercial |
$952.90
|
| Rate for Payer: Quartz Medicare Advantage |
$879.60
|
| Rate for Payer: The Alliance Commercial |
$5,864.00
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
|
DRILL BIT MATRIX 1.25MM 03.503.121
|
Facility
|
IP
|
$1,466.00
|
|
| Hospital Charge Code |
5298652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$1,348.72 |
| Rate for Payer: Aetna Commercial |
$1,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.98
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,348.72
|
| Rate for Payer: Health EOS Commercial |
$1,304.74
|
| Rate for Payer: HFN Commercial |
$1,348.72
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.72
|
| Rate for Payer: Quartz Beloit One Network |
$718.34
|
| Rate for Payer: Quartz Commercial |
$879.60
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
