|
DRILL BIT MEMOFIX 1.7MM MS2610
|
Facility
|
IP
|
$4,878.00
|
|
| Hospital Charge Code |
5521016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,390.22 |
| Max. Negotiated Rate |
$4,487.76 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$2,926.80
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
|
DRILL BIT MEMOFIX 1.7MM MS2610
|
Facility
|
OP
|
$4,878.00
|
|
| Hospital Charge Code |
5521016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,365.84 |
| Max. Negotiated Rate |
$19,512.00 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,365.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,170.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,439.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,341.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,729.73
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,658.50
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$3,170.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,926.80
|
| Rate for Payer: The Alliance Commercial |
$19,512.00
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
|
DRILL BIT MINI 1.8MM 80MM QC 317.861
|
Facility
|
OP
|
$792.00
|
|
| Hospital Charge Code |
4508846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$475.20
|
| Rate for Payer: The Alliance Commercial |
$3,168.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
DRILL BIT MINI 1.8MM 80MM QC 317.861
|
Facility
|
IP
|
$792.00
|
|
| Hospital Charge Code |
4508846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
DRILL BIT MINI 2.4MM 80MM QC 317.871
|
Facility
|
OP
|
$792.00
|
|
| Hospital Charge Code |
4508847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$475.20
|
| Rate for Payer: The Alliance Commercial |
$3,168.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
DRILL BIT MINI 2.4MM 80MM QC 317.871
|
Facility
|
IP
|
$792.00
|
|
| Hospital Charge Code |
4508847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
DRILL BIT MINI LONG ACUTRAK 2 AT2M-L1813
|
Facility
|
IP
|
$3,168.00
|
|
| Hospital Charge Code |
2964140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,552.32 |
| Max. Negotiated Rate |
$2,914.56 |
| Rate for Payer: Aetna Commercial |
$2,851.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,724.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,679.04
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$2,914.56
|
| Rate for Payer: Health EOS Commercial |
$2,819.52
|
| Rate for Payer: HFN Commercial |
$2,914.56
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,900.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,914.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,552.32
|
| Rate for Payer: Quartz Commercial |
$1,900.80
|
| Rate for Payer: WEA Trust Commercial |
$1,742.40
|
| Rate for Payer: WPS Commercial |
$2,346.54
|
|
|
DRILL BIT MINI LONG ACUTRAK 2 AT2M-L1813
|
Facility
|
OP
|
$3,168.00
|
|
| Hospital Charge Code |
2964140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.04 |
| Max. Negotiated Rate |
$12,672.00 |
| Rate for Payer: Aetna Commercial |
$2,851.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,724.48
|
| Rate for Payer: Aetna Managed Medicare |
$887.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,059.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,584.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,520.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,679.04
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$2,914.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,772.81
|
| Rate for Payer: Health EOS Commercial |
$2,819.52
|
| Rate for Payer: HFN Commercial |
$2,914.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,376.00
|
| Rate for Payer: Multiplan Commercial |
$2,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,900.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,914.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,552.32
|
| Rate for Payer: Quartz Commercial |
$2,059.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,900.80
|
| Rate for Payer: The Alliance Commercial |
$12,672.00
|
| Rate for Payer: WEA Trust Commercial |
$1,742.40
|
| Rate for Payer: WPS Commercial |
$2,346.54
|
|
|
DRILL BIT OLECRANON OSTEOTOMY
|
Facility
|
OP
|
$5,137.00
|
|
| Hospital Charge Code |
2966217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,438.36 |
| Max. Negotiated Rate |
$20,548.00 |
| Rate for Payer: Aetna Commercial |
$4,623.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,417.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,438.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,339.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,568.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,465.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,722.61
|
| Rate for Payer: Cash Price |
$1,541.10
|
| Rate for Payer: Cigna Commercial |
$4,726.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,874.67
|
| Rate for Payer: Health EOS Commercial |
$4,571.93
|
| Rate for Payer: HFN Commercial |
$4,726.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,852.75
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,726.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,517.13
|
| Rate for Payer: Quartz Commercial |
$3,339.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,082.20
|
| Rate for Payer: The Alliance Commercial |
$20,548.00
|
| Rate for Payer: WEA Trust Commercial |
$2,825.35
|
| Rate for Payer: WPS Commercial |
$3,804.98
|
|
|
DRILL BIT OLECRANON OSTEOTOMY
|
Facility
|
IP
|
$5,137.00
|
|
| Hospital Charge Code |
2966217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,517.13 |
| Max. Negotiated Rate |
$4,726.04 |
| Rate for Payer: Aetna Commercial |
$4,623.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,417.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,722.61
|
| Rate for Payer: Cash Price |
$1,541.10
|
| Rate for Payer: Cigna Commercial |
$4,726.04
|
| Rate for Payer: Health EOS Commercial |
$4,571.93
|
| Rate for Payer: HFN Commercial |
$4,726.04
|
| Rate for Payer: Multiplan Commercial |
$4,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,726.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,517.13
|
| Rate for Payer: Quartz Commercial |
$3,082.20
|
| Rate for Payer: WEA Trust Commercial |
$2,825.35
|
| Rate for Payer: WPS Commercial |
$3,804.98
|
|
|
DRILL BIT OPENING 5.5MM 2358-2000
|
Facility
|
OP
|
$4,190.00
|
|
| Hospital Charge Code |
6171932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.20 |
| Max. Negotiated Rate |
$16,760.00 |
| Rate for Payer: Aetna Commercial |
$3,771.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,603.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,173.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,723.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,011.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,220.70
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$3,854.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,344.72
|
| Rate for Payer: Health EOS Commercial |
$3,729.10
|
| Rate for Payer: HFN Commercial |
$3,854.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,142.50
|
| Rate for Payer: Multiplan Commercial |
$3,352.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,514.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,854.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,053.10
|
| Rate for Payer: Quartz Commercial |
$2,723.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,514.00
|
| Rate for Payer: The Alliance Commercial |
$16,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,304.50
|
| Rate for Payer: WPS Commercial |
$3,103.53
|
|
|
DRILL BIT OPENING 5.5MM 2358-2000
|
Facility
|
IP
|
$4,190.00
|
|
| Hospital Charge Code |
6171932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,053.10 |
| Max. Negotiated Rate |
$3,854.80 |
| Rate for Payer: Aetna Commercial |
$3,771.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,603.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,220.70
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$3,854.80
|
| Rate for Payer: Health EOS Commercial |
$3,729.10
|
| Rate for Payer: HFN Commercial |
$3,854.80
|
| Rate for Payer: Multiplan Commercial |
$3,352.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,514.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,854.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,053.10
|
| Rate for Payer: Quartz Commercial |
$2,514.00
|
| Rate for Payer: WEA Trust Commercial |
$2,304.50
|
| Rate for Payer: WPS Commercial |
$3,103.53
|
|
|
DRILL BIT PERIPHERAL SCREW 2.7MM 405889
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
6165986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.76 |
| Max. Negotiated Rate |
$1,862.08 |
| Rate for Payer: Aetna Commercial |
$1,821.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.72
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,862.08
|
| Rate for Payer: Health EOS Commercial |
$1,801.36
|
| Rate for Payer: HFN Commercial |
$1,862.08
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.08
|
| Rate for Payer: Quartz Beloit One Network |
$991.76
|
| Rate for Payer: Quartz Commercial |
$1,214.40
|
| Rate for Payer: WEA Trust Commercial |
$1,113.20
|
| Rate for Payer: WPS Commercial |
$1,499.18
|
|
|
DRILL BIT PERIPHERAL SCREW 2.7MM 405889
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
6165986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.72 |
| Max. Negotiated Rate |
$8,096.00 |
| Rate for Payer: Aetna Commercial |
$1,821.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.64
|
| Rate for Payer: Aetna Managed Medicare |
$566.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,315.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.72
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,862.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,132.63
|
| Rate for Payer: Health EOS Commercial |
$1,801.36
|
| Rate for Payer: HFN Commercial |
$1,862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.00
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.08
|
| Rate for Payer: Quartz Beloit One Network |
$991.76
|
| Rate for Payer: Quartz Commercial |
$1,315.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.40
|
| Rate for Payer: The Alliance Commercial |
$8,096.00
|
| Rate for Payer: WEA Trust Commercial |
$1,113.20
|
| Rate for Payer: WPS Commercial |
$1,499.18
|
|
|
DRILL BIT PILOT TRILLIANT 510-10-002
|
Facility
|
IP
|
$2,394.00
|
|
| Hospital Charge Code |
5414670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
DRILL BIT PILOT TRILLIANT 510-10-002
|
Facility
|
OP
|
$2,394.00
|
|
| Hospital Charge Code |
5414670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
DRILL BIT SCALED 2.6 X 220MM AO FIT 2358-0050
|
Facility
|
OP
|
$3,885.00
|
|
| Hospital Charge Code |
6171931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.80 |
| Max. Negotiated Rate |
$15,540.00 |
| Rate for Payer: Aetna Commercial |
$3,496.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,525.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,864.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.05
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna Commercial |
$3,574.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,174.05
|
| Rate for Payer: Health EOS Commercial |
$3,457.65
|
| Rate for Payer: HFN Commercial |
$3,574.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,913.75
|
| Rate for Payer: Multiplan Commercial |
$3,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.65
|
| Rate for Payer: Quartz Commercial |
$2,525.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,331.00
|
| Rate for Payer: The Alliance Commercial |
$15,540.00
|
| Rate for Payer: WEA Trust Commercial |
$2,136.75
|
| Rate for Payer: WPS Commercial |
$2,877.62
|
|
|
DRILL BIT SCALED 2.6 X 220MM AO FIT 2358-0050
|
Facility
|
IP
|
$3,885.00
|
|
| Hospital Charge Code |
6171931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,903.65 |
| Max. Negotiated Rate |
$3,574.20 |
| Rate for Payer: Aetna Commercial |
$3,496.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.05
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna Commercial |
$3,574.20
|
| Rate for Payer: Health EOS Commercial |
$3,457.65
|
| Rate for Payer: HFN Commercial |
$3,574.20
|
| Rate for Payer: Multiplan Commercial |
$3,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.65
|
| Rate for Payer: Quartz Commercial |
$2,331.00
|
| Rate for Payer: WEA Trust Commercial |
$2,136.75
|
| Rate for Payer: WPS Commercial |
$2,877.62
|
|
|
DRILL BIT STANDARD 2.0MM X 110MM AO XFO082001
|
Facility
|
OP
|
$2,763.00
|
|
| Hospital Charge Code |
5591287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.64 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$2,486.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,376.18
|
| Rate for Payer: Aetna Managed Medicare |
$773.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,795.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,381.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,326.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,464.39
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna Commercial |
$2,541.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,546.17
|
| Rate for Payer: Health EOS Commercial |
$2,459.07
|
| Rate for Payer: HFN Commercial |
$2,541.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,072.25
|
| Rate for Payer: Multiplan Commercial |
$2,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.87
|
| Rate for Payer: Quartz Commercial |
$1,795.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,657.80
|
| Rate for Payer: The Alliance Commercial |
$11,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,519.65
|
| Rate for Payer: WPS Commercial |
$2,046.55
|
|
|
DRILL BIT STANDARD 2.0MM X 110MM AO XFO082001
|
Facility
|
IP
|
$2,763.00
|
|
| Hospital Charge Code |
5591287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,353.87 |
| Max. Negotiated Rate |
$2,541.96 |
| Rate for Payer: Aetna Commercial |
$2,486.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,376.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,464.39
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna Commercial |
$2,541.96
|
| Rate for Payer: Health EOS Commercial |
$2,459.07
|
| Rate for Payer: HFN Commercial |
$2,541.96
|
| Rate for Payer: Multiplan Commercial |
$2,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,657.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,541.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.87
|
| Rate for Payer: Quartz Commercial |
$1,657.80
|
| Rate for Payer: WEA Trust Commercial |
$1,519.65
|
| Rate for Payer: WPS Commercial |
$2,046.55
|
|
|
DRILL BIT STEPPED 4.5/6.5MM LARGE QC 03.010.078
|
Facility
|
IP
|
$3,418.00
|
|
| Hospital Charge Code |
3127488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,674.82 |
| Max. Negotiated Rate |
$3,144.56 |
| Rate for Payer: Aetna Commercial |
$3,076.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.54
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cigna Commercial |
$3,144.56
|
| Rate for Payer: Health EOS Commercial |
$3,042.02
|
| Rate for Payer: HFN Commercial |
$3,144.56
|
| Rate for Payer: Multiplan Commercial |
$2,734.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,050.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,144.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,674.82
|
| Rate for Payer: Quartz Commercial |
$2,050.80
|
| Rate for Payer: WEA Trust Commercial |
$1,879.90
|
| Rate for Payer: WPS Commercial |
$2,531.71
|
|
|
DRILL BIT STEPPED 4.5/6.5MM LARGE QC 03.010.078
|
Facility
|
OP
|
$3,418.00
|
|
| Hospital Charge Code |
3127488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.04 |
| Max. Negotiated Rate |
$13,672.00 |
| Rate for Payer: Aetna Commercial |
$3,076.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.48
|
| Rate for Payer: Aetna Managed Medicare |
$957.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,221.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,709.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,640.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.54
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cigna Commercial |
$3,144.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,912.71
|
| Rate for Payer: Health EOS Commercial |
$3,042.02
|
| Rate for Payer: HFN Commercial |
$3,144.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,563.50
|
| Rate for Payer: Multiplan Commercial |
$2,734.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,050.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,144.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,674.82
|
| Rate for Payer: Quartz Commercial |
$2,221.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,050.80
|
| Rate for Payer: The Alliance Commercial |
$13,672.00
|
| Rate for Payer: WEA Trust Commercial |
$1,879.90
|
| Rate for Payer: WPS Commercial |
$2,531.71
|
|
|
DRILL BIT THREADED PILOT 214-00-013
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
4508843
|
|
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 THREADED PILOT 214-00-013
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
4508843
|
|
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 THREADED PILOT 214-00-017
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5547270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
