|
DRILL BIT 1.1MM 75MM 03.114.007
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
2966174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.71 |
| 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: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| 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: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
DRILL BIT 1.1MM J-LATCH 317.235.96
|
Facility
|
IP
|
$2,040.00
|
|
| Hospital Charge Code |
2966145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,039.58 |
| Max. Negotiated Rate |
$1,951.87 |
| Rate for Payer: Aetna Commercial |
$1,909.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.45
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,951.87
|
| Rate for Payer: Health EOS Commercial |
$1,888.22
|
| Rate for Payer: HFN Commercial |
$1,951.87
|
| Rate for Payer: Multiplan Commercial |
$1,697.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.58
|
| Rate for Payer: Quartz Commercial |
$1,272.96
|
| Rate for Payer: WEA Trust Commercial |
$1,166.88
|
| Rate for Payer: WPS Commercial |
$1,571.41
|
|
|
DRILL BIT 1.1MM J-LATCH 317.235.96
|
Facility
|
OP
|
$2,040.00
|
|
| Hospital Charge Code |
2966145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.05 |
| Max. Negotiated Rate |
$1,951.87 |
| Rate for Payer: Aetna Commercial |
$1,909.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.58
|
| Rate for Payer: Aetna Managed Medicare |
$594.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,379.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.45
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,951.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,187.28
|
| Rate for Payer: Health EOS Commercial |
$1,888.22
|
| Rate for Payer: HFN Commercial |
$1,951.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.20
|
| Rate for Payer: Multiplan Commercial |
$1,697.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.58
|
| Rate for Payer: Quartz Commercial |
$1,379.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.96
|
| Rate for Payer: The Alliance Commercial |
$1,060.80
|
| Rate for Payer: WEA Trust Commercial |
$1,166.88
|
| Rate for Payer: WPS Commercial |
$1,571.41
|
|
|
DRILL BIT 1.1MM X12.7CM 00-2318-011-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
4097727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.51 |
| Max. Negotiated Rate |
$836.24 |
| Rate for Payer: Aetna Commercial |
$818.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.71
|
| Rate for Payer: Aetna Managed Medicare |
$254.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$590.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$454.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.75
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$836.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.67
|
| Rate for Payer: Health EOS Commercial |
$808.97
|
| Rate for Payer: HFN Commercial |
$836.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$727.17
|
| Rate for Payer: NAPHCARE Commercial |
$545.38
|
| Rate for Payer: Preferred Network Access Commercial |
$836.24
|
| Rate for Payer: Quartz Beloit One Network |
$445.39
|
| Rate for Payer: Quartz Commercial |
$590.82
|
| Rate for Payer: Quartz Medicare Advantage |
$545.38
|
| Rate for Payer: The Alliance Commercial |
$454.48
|
| Rate for Payer: WEA Trust Commercial |
$499.93
|
| Rate for Payer: WPS Commercial |
$673.24
|
|
|
DRILL BIT 1.1MM X12.7CM 00-2318-011-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
4097727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.39 |
| Max. Negotiated Rate |
$836.24 |
| Rate for Payer: Aetna Commercial |
$818.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.75
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$836.24
|
| Rate for Payer: Health EOS Commercial |
$808.97
|
| Rate for Payer: HFN Commercial |
$836.24
|
| Rate for Payer: Multiplan Commercial |
$727.17
|
| Rate for Payer: Preferred Network Access Commercial |
$836.24
|
| Rate for Payer: Quartz Beloit One Network |
$445.39
|
| Rate for Payer: Quartz Commercial |
$545.38
|
| Rate for Payer: WEA Trust Commercial |
$499.93
|
| Rate for Payer: WPS Commercial |
$673.24
|
|
|
DRILL BIT 1.1MM X 65MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.201
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861729
|
|
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 1.1MM X 65MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.201
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861729
|
|
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 1.1x5.0 WITH STOP
|
Facility
|
OP
|
$2,075.00
|
|
| Hospital Charge Code |
2965250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.24 |
| Max. Negotiated Rate |
$1,985.36 |
| Rate for Payer: Aetna Commercial |
$1,942.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,855.88
|
| Rate for Payer: Aetna Managed Medicare |
$604.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,402.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,079.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,035.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,143.74
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,207.65
|
| Rate for Payer: Health EOS Commercial |
$1,920.62
|
| Rate for Payer: HFN Commercial |
$1,985.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,618.50
|
| Rate for Payer: Multiplan Commercial |
$1,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,294.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,985.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.42
|
| Rate for Payer: Quartz Commercial |
$1,402.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,294.80
|
| Rate for Payer: The Alliance Commercial |
$1,079.00
|
| Rate for Payer: WEA Trust Commercial |
$1,186.90
|
| Rate for Payer: WPS Commercial |
$1,598.37
|
|
|
DRILL BIT 1.1x5.0 WITH STOP
|
Facility
|
IP
|
$2,075.00
|
|
| Hospital Charge Code |
2965250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,057.42 |
| Max. Negotiated Rate |
$1,985.36 |
| Rate for Payer: Aetna Commercial |
$1,942.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,855.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,143.74
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: Health EOS Commercial |
$1,920.62
|
| Rate for Payer: HFN Commercial |
$1,985.36
|
| Rate for Payer: Multiplan Commercial |
$1,726.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,985.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.42
|
| Rate for Payer: Quartz Commercial |
$1,294.80
|
| Rate for Payer: WEA Trust Commercial |
$1,186.90
|
| Rate for Payer: WPS Commercial |
$1,598.37
|
|
|
DRILL BIT 12.7m STEMMED TIBIAL
|
Facility
|
IP
|
$2,897.00
|
|
| Hospital Charge Code |
2967463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,476.31 |
| Max. Negotiated Rate |
$2,771.85 |
| Rate for Payer: Aetna Commercial |
$2,711.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,591.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,596.83
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,771.85
|
| Rate for Payer: Health EOS Commercial |
$2,681.46
|
| Rate for Payer: HFN Commercial |
$2,771.85
|
| Rate for Payer: Multiplan Commercial |
$2,410.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,771.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,476.31
|
| Rate for Payer: Quartz Commercial |
$1,807.73
|
| Rate for Payer: WEA Trust Commercial |
$1,657.08
|
| Rate for Payer: WPS Commercial |
$2,231.56
|
|
|
DRILL BIT 12.7m STEMMED TIBIAL
|
Facility
|
OP
|
$2,897.00
|
|
| Hospital Charge Code |
2967463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.61 |
| Max. Negotiated Rate |
$2,771.85 |
| Rate for Payer: Aetna Commercial |
$2,711.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,591.08
|
| Rate for Payer: Aetna Managed Medicare |
$843.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,958.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,506.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,446.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,596.83
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,771.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,686.05
|
| Rate for Payer: Health EOS Commercial |
$2,681.46
|
| Rate for Payer: HFN Commercial |
$2,771.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,259.66
|
| Rate for Payer: Multiplan Commercial |
$2,410.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,807.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,771.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,476.31
|
| Rate for Payer: Quartz Commercial |
$1,958.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,807.73
|
| Rate for Payer: The Alliance Commercial |
$1,506.44
|
| Rate for Payer: WEA Trust Commercial |
$1,657.08
|
| Rate for Payer: WPS Commercial |
$2,231.56
|
|
|
DRILL BIT 12.8 CALIBRATED LRG QC 03.233.001
|
Facility
|
IP
|
$6,167.00
|
|
| Hospital Charge Code |
6175470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,142.70 |
| Max. Negotiated Rate |
$5,900.59 |
| Rate for Payer: Aetna Commercial |
$5,772.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,515.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,399.25
|
| Rate for Payer: Cash Price |
$1,850.10
|
| Rate for Payer: Cigna Commercial |
$5,900.59
|
| Rate for Payer: Health EOS Commercial |
$5,708.18
|
| Rate for Payer: HFN Commercial |
$5,900.59
|
| Rate for Payer: Multiplan Commercial |
$5,130.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,900.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,142.70
|
| Rate for Payer: Quartz Commercial |
$3,848.21
|
| Rate for Payer: WEA Trust Commercial |
$3,527.52
|
| Rate for Payer: WPS Commercial |
$4,750.44
|
|
|
DRILL BIT 12.8 CALIBRATED LRG QC 03.233.001
|
Facility
|
OP
|
$6,167.00
|
|
| Hospital Charge Code |
6175470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,795.83 |
| Max. Negotiated Rate |
$5,900.59 |
| Rate for Payer: Aetna Commercial |
$5,772.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,515.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,795.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,168.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,206.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,078.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,399.25
|
| Rate for Payer: Cash Price |
$1,850.10
|
| Rate for Payer: Cigna Commercial |
$5,900.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,589.19
|
| Rate for Payer: Health EOS Commercial |
$5,708.18
|
| Rate for Payer: HFN Commercial |
$5,900.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,810.26
|
| Rate for Payer: Multiplan Commercial |
$5,130.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,848.21
|
| Rate for Payer: Preferred Network Access Commercial |
$5,900.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,142.70
|
| Rate for Payer: Quartz Commercial |
$4,168.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,848.21
|
| Rate for Payer: The Alliance Commercial |
$3,206.84
|
| Rate for Payer: WEA Trust Commercial |
$3,527.52
|
| Rate for Payer: WPS Commercial |
$4,750.44
|
|
|
DRILL BIT 1.3MM J-LATCH 316.335.96
|
Facility
|
OP
|
$2,137.00
|
|
| Hospital Charge Code |
2966146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.29 |
| Max. Negotiated Rate |
$2,044.68 |
| Rate for Payer: Aetna Commercial |
$2,000.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Aetna Managed Medicare |
$622.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,444.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,111.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,066.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.91
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,044.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,243.73
|
| Rate for Payer: Health EOS Commercial |
$1,978.01
|
| Rate for Payer: HFN Commercial |
$2,044.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,666.86
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,333.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,044.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.02
|
| Rate for Payer: Quartz Commercial |
$1,444.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,333.49
|
| Rate for Payer: The Alliance Commercial |
$1,111.24
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: WPS Commercial |
$1,646.13
|
|
|
DRILL BIT 1.3MM J-LATCH 316.335.96
|
Facility
|
IP
|
$2,137.00
|
|
| Hospital Charge Code |
2966146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.02 |
| Max. Negotiated Rate |
$2,044.68 |
| Rate for Payer: Aetna Commercial |
$2,000.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.91
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,044.68
|
| Rate for Payer: Health EOS Commercial |
$1,978.01
|
| Rate for Payer: HFN Commercial |
$2,044.68
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,044.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.02
|
| Rate for Payer: Quartz Commercial |
$1,333.49
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: WPS Commercial |
$1,646.13
|
|
|
DRILL BIT 1.3MM (MINI QUICK COUPLING FOR GLIDING HOLE) 03.130.112
|
Facility
|
OP
|
$1,394.00
|
|
| Hospital Charge Code |
6173405
|
|
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 1.3MM (MINI QUICK COUPLING FOR GLIDING HOLE) 03.130.112
|
Facility
|
IP
|
$1,394.00
|
|
| Hospital Charge Code |
6173405
|
|
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 1.3MM (STRYKER J-LATCH FOR GLIDING HOLE) 03.130.111
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861731
|
|
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 1.3MM (STRYKER J-LATCH FOR GLIDING HOLE) 03.130.111
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861731
|
|
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 1.3MMX55MM MINI QC 316.402
|
Facility
|
IP
|
$792.00
|
|
| Hospital Charge Code |
4508845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
DRILL BIT 1.3MMX55MM MINI QC 316.402
|
Facility
|
OP
|
$792.00
|
|
| Hospital Charge Code |
4508845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$494.21
|
| Rate for Payer: The Alliance Commercial |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
DRILL BIT 1.4MM X 27MM AO 60-14326
|
Facility
|
OP
|
$989.00
|
|
| Hospital Charge Code |
4595583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$946.28 |
| Rate for Payer: Aetna Commercial |
$925.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.56
|
| Rate for Payer: Aetna Managed Medicare |
$288.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$668.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$514.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.14
|
| Rate for Payer: Cash Price |
$296.70
|
| Rate for Payer: Cigna Commercial |
$946.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.60
|
| Rate for Payer: Health EOS Commercial |
$915.42
|
| Rate for Payer: HFN Commercial |
$946.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$771.42
|
| Rate for Payer: Multiplan Commercial |
$822.85
|
| Rate for Payer: NAPHCARE Commercial |
$617.14
|
| Rate for Payer: Preferred Network Access Commercial |
$946.28
|
| Rate for Payer: Quartz Beloit One Network |
$503.99
|
| Rate for Payer: Quartz Commercial |
$668.56
|
| Rate for Payer: Quartz Medicare Advantage |
$617.14
|
| Rate for Payer: The Alliance Commercial |
$514.28
|
| Rate for Payer: WEA Trust Commercial |
$565.71
|
| Rate for Payer: WPS Commercial |
$761.83
|
|
|
DRILL BIT 1.4MM X 27MM AO 60-14326
|
Facility
|
IP
|
$989.00
|
|
| Hospital Charge Code |
4595583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.99 |
| Max. Negotiated Rate |
$946.28 |
| Rate for Payer: Aetna Commercial |
$925.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.14
|
| Rate for Payer: Cash Price |
$296.70
|
| Rate for Payer: Cigna Commercial |
$946.28
|
| Rate for Payer: Health EOS Commercial |
$915.42
|
| Rate for Payer: HFN Commercial |
$946.28
|
| Rate for Payer: Multiplan Commercial |
$822.85
|
| Rate for Payer: Preferred Network Access Commercial |
$946.28
|
| Rate for Payer: Quartz Beloit One Network |
$503.99
|
| Rate for Payer: Quartz Commercial |
$617.14
|
| Rate for Payer: WEA Trust Commercial |
$565.71
|
| Rate for Payer: WPS Commercial |
$761.83
|
|
|
DRILL BIT 1.4 X 150MM ASNIS III 702448
|
Facility
|
IP
|
$1,467.00
|
|
| Hospital Charge Code |
6211057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.58 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$915.41
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
DRILL BIT 1.4 X 150MM ASNIS III 702448
|
Facility
|
OP
|
$1,467.00
|
|
| Hospital Charge Code |
6211057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.19 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Aetna Managed Medicare |
$427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.79
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,144.26
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: NAPHCARE Commercial |
$915.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$991.69
|
| Rate for Payer: Quartz Medicare Advantage |
$915.41
|
| Rate for Payer: The Alliance Commercial |
$762.84
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
