|
DRILL BIT THREADED PILOT 214-00-017
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5547270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Aetna Managed Medicare |
$744.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.80
|
| 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: Dean Health DHI/DHP/ASO |
$1,488.54
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.00
|
| 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 |
$1,729.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.00
|
| Rate for Payer: The Alliance Commercial |
$10,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRILL BIT TRILLIANT TIGER 3.0/4.O 210-40-001
|
Facility
|
OP
|
$3,048.00
|
|
| Hospital Charge Code |
3323483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$853.44 |
| Max. Negotiated Rate |
$12,192.00 |
| Rate for Payer: Aetna Commercial |
$2,743.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.28
|
| Rate for Payer: Aetna Managed Medicare |
$853.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,981.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,524.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,463.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.44
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,804.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,705.66
|
| Rate for Payer: Health EOS Commercial |
$2,712.72
|
| Rate for Payer: HFN Commercial |
$2,804.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,286.00
|
| Rate for Payer: Multiplan Commercial |
$2,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.52
|
| Rate for Payer: Quartz Commercial |
$1,981.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,828.80
|
| Rate for Payer: The Alliance Commercial |
$12,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,676.40
|
| Rate for Payer: WPS Commercial |
$2,257.65
|
|
|
DRILL BIT TRILLIANT TIGER 3.0/4.O 210-40-001
|
Facility
|
IP
|
$3,048.00
|
|
| Hospital Charge Code |
3323483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,493.52 |
| Max. Negotiated Rate |
$2,804.16 |
| Rate for Payer: Aetna Commercial |
$2,743.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.44
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,804.16
|
| Rate for Payer: Health EOS Commercial |
$2,712.72
|
| Rate for Payer: HFN Commercial |
$2,804.16
|
| Rate for Payer: Multiplan Commercial |
$2,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.52
|
| Rate for Payer: Quartz Commercial |
$1,828.80
|
| Rate for Payer: WEA Trust Commercial |
$1,676.40
|
| Rate for Payer: WPS Commercial |
$2,257.65
|
|
|
DRILL BIT TROCAR 1.5MM 100MM QC WITH 6MM STOP 317.875
|
Facility
|
IP
|
$2,783.00
|
|
| Hospital Charge Code |
6172585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.67 |
| Max. Negotiated Rate |
$2,560.36 |
| Rate for Payer: Aetna Commercial |
$2,504.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,393.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,474.99
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cigna Commercial |
$2,560.36
|
| Rate for Payer: Health EOS Commercial |
$2,476.87
|
| Rate for Payer: HFN Commercial |
$2,560.36
|
| Rate for Payer: Multiplan Commercial |
$2,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,669.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.67
|
| Rate for Payer: Quartz Commercial |
$1,669.80
|
| Rate for Payer: WEA Trust Commercial |
$1,530.65
|
| Rate for Payer: WPS Commercial |
$2,061.37
|
|
|
DRILL BIT TROCAR 1.5MM 100MM QC WITH 6MM STOP 317.875
|
Facility
|
OP
|
$2,783.00
|
|
| Hospital Charge Code |
6172585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.24 |
| Max. Negotiated Rate |
$11,132.00 |
| Rate for Payer: Aetna Commercial |
$2,504.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,393.38
|
| Rate for Payer: Aetna Managed Medicare |
$779.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,808.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,391.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,335.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,474.99
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cigna Commercial |
$2,560.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,557.37
|
| Rate for Payer: Health EOS Commercial |
$2,476.87
|
| Rate for Payer: HFN Commercial |
$2,560.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,087.25
|
| Rate for Payer: Multiplan Commercial |
$2,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,669.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.67
|
| Rate for Payer: Quartz Commercial |
$1,808.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,669.80
|
| Rate for Payer: The Alliance Commercial |
$11,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,530.65
|
| Rate for Payer: WPS Commercial |
$2,061.37
|
|
|
DRILL BIT TWIST 4.75MM SWIVELOCK AR-2276D
|
Facility
|
OP
|
$1,486.00
|
|
| Hospital Charge Code |
5591321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.08 |
| Max. Negotiated Rate |
$5,944.00 |
| Rate for Payer: Aetna Commercial |
$1,337.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.96
|
| Rate for Payer: Aetna Managed Medicare |
$416.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$743.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$713.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.58
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,367.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$831.57
|
| Rate for Payer: Health EOS Commercial |
$1,322.54
|
| Rate for Payer: HFN Commercial |
$1,367.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,114.50
|
| Rate for Payer: Multiplan Commercial |
$1,188.80
|
| Rate for Payer: NAPHCARE Commercial |
$891.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.12
|
| Rate for Payer: Quartz Beloit One Network |
$728.14
|
| Rate for Payer: Quartz Commercial |
$965.90
|
| Rate for Payer: Quartz Medicare Advantage |
$891.60
|
| Rate for Payer: The Alliance Commercial |
$5,944.00
|
| Rate for Payer: WEA Trust Commercial |
$817.30
|
| Rate for Payer: WPS Commercial |
$1,100.68
|
|
|
DRILL BIT TWIST 4.75MM SWIVELOCK AR-2276D
|
Facility
|
IP
|
$1,486.00
|
|
| Hospital Charge Code |
5591321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.14 |
| Max. Negotiated Rate |
$1,367.12 |
| Rate for Payer: Aetna Commercial |
$1,337.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.58
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,367.12
|
| Rate for Payer: Health EOS Commercial |
$1,322.54
|
| Rate for Payer: HFN Commercial |
$1,367.12
|
| Rate for Payer: Multiplan Commercial |
$1,188.80
|
| Rate for Payer: NAPHCARE Commercial |
$891.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.12
|
| Rate for Payer: Quartz Beloit One Network |
$728.14
|
| Rate for Payer: Quartz Commercial |
$891.60
|
| Rate for Payer: WEA Trust Commercial |
$817.30
|
| Rate for Payer: WPS Commercial |
$1,100.68
|
|
|
DRILL BIT X-FUSE MEDIAL/DISTAL STOP XFO102001
|
Facility
|
OP
|
$1,520.00
|
|
| Hospital Charge Code |
4519442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$6,080.00 |
| Rate for Payer: Aetna Commercial |
$1,368.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Aetna Managed Medicare |
$425.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$988.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$760.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.60
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,398.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.59
|
| Rate for Payer: Health EOS Commercial |
$1,352.80
|
| Rate for Payer: HFN Commercial |
$1,398.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$1,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.80
|
| Rate for Payer: Quartz Commercial |
$988.00
|
| Rate for Payer: Quartz Medicare Advantage |
$912.00
|
| Rate for Payer: The Alliance Commercial |
$6,080.00
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
DRILL BIT X-FUSE MEDIAL/DISTAL STOP XFO102001
|
Facility
|
IP
|
$1,520.00
|
|
| Hospital Charge Code |
4519442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Aetna Commercial |
$1,368.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.60
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,398.40
|
| Rate for Payer: Health EOS Commercial |
$1,352.80
|
| Rate for Payer: HFN Commercial |
$1,398.40
|
| Rate for Payer: Multiplan Commercial |
$1,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.80
|
| Rate for Payer: Quartz Commercial |
$912.00
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
DRILL BIT X-FUSE PROXIMAL 2MM XFO112001
|
Facility
|
IP
|
$1,520.00
|
|
| Hospital Charge Code |
4519441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Aetna Commercial |
$1,368.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.60
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,398.40
|
| Rate for Payer: Health EOS Commercial |
$1,352.80
|
| Rate for Payer: HFN Commercial |
$1,398.40
|
| Rate for Payer: Multiplan Commercial |
$1,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.80
|
| Rate for Payer: Quartz Commercial |
$912.00
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
DRILL BIT X-FUSE PROXIMAL 2MM XFO112001
|
Facility
|
OP
|
$1,520.00
|
|
| Hospital Charge Code |
4519441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.60 |
| Max. Negotiated Rate |
$6,080.00 |
| Rate for Payer: Aetna Commercial |
$1,368.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Aetna Managed Medicare |
$425.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$988.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$760.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.60
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,398.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.59
|
| Rate for Payer: Health EOS Commercial |
$1,352.80
|
| Rate for Payer: HFN Commercial |
$1,398.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$1,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.80
|
| Rate for Payer: Quartz Commercial |
$988.00
|
| Rate for Payer: Quartz Medicare Advantage |
$912.00
|
| Rate for Payer: The Alliance Commercial |
$6,080.00
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
DRILL CALIBRATED, 4.0MM X 280MM S0219-100
|
Facility
|
IP
|
$2,929.00
|
|
| Hospital Charge Code |
6232144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,435.21 |
| Max. Negotiated Rate |
$2,694.68 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,757.40
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
DRILL CALIBRATED, 4.0MM X 280MM S0219-100
|
Facility
|
OP
|
$2,929.00
|
|
| Hospital Charge Code |
6232144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$820.12 |
| Max. Negotiated Rate |
$11,716.00 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Aetna Managed Medicare |
$820.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,903.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.07
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,196.75
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,903.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.40
|
| Rate for Payer: The Alliance Commercial |
$11,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
|
DRILL FLIP CUTTER III AR-1204FF
|
Facility
|
OP
|
$4,415.00
|
|
| Hospital Charge Code |
5547218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,236.20 |
| Max. Negotiated Rate |
$17,660.00 |
| Rate for Payer: Aetna Commercial |
$3,973.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,796.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,236.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,869.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,207.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,119.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,339.95
|
| Rate for Payer: Cash Price |
$1,324.50
|
| Rate for Payer: Cigna Commercial |
$4,061.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,470.63
|
| Rate for Payer: Health EOS Commercial |
$3,929.35
|
| Rate for Payer: HFN Commercial |
$4,061.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,311.25
|
| Rate for Payer: Multiplan Commercial |
$3,532.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,649.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,061.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,163.35
|
| Rate for Payer: Quartz Commercial |
$2,869.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,649.00
|
| Rate for Payer: The Alliance Commercial |
$17,660.00
|
| Rate for Payer: WEA Trust Commercial |
$2,428.25
|
| Rate for Payer: WPS Commercial |
$3,270.19
|
|
|
DRILL FLIP CUTTER III AR-1204FF
|
Facility
|
IP
|
$4,415.00
|
|
| Hospital Charge Code |
5547218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,163.35 |
| Max. Negotiated Rate |
$4,061.80 |
| Rate for Payer: Aetna Commercial |
$3,973.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,796.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,339.95
|
| Rate for Payer: Cash Price |
$1,324.50
|
| Rate for Payer: Cigna Commercial |
$4,061.80
|
| Rate for Payer: Health EOS Commercial |
$3,929.35
|
| Rate for Payer: HFN Commercial |
$4,061.80
|
| Rate for Payer: Multiplan Commercial |
$3,532.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,649.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,061.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,163.35
|
| Rate for Payer: Quartz Commercial |
$2,649.00
|
| Rate for Payer: WEA Trust Commercial |
$2,428.25
|
| Rate for Payer: WPS Commercial |
$3,270.19
|
|
|
DRILL FREEHAND 4.2 X 130MM IMN 2351-4213S
|
Facility
|
IP
|
$2,764.00
|
|
| Hospital Charge Code |
5599786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,354.36 |
| Max. Negotiated Rate |
$2,542.88 |
| Rate for Payer: Aetna Commercial |
$2,487.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,377.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,464.92
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$2,542.88
|
| Rate for Payer: Health EOS Commercial |
$2,459.96
|
| Rate for Payer: HFN Commercial |
$2,542.88
|
| Rate for Payer: Multiplan Commercial |
$2,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,658.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,542.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,354.36
|
| Rate for Payer: Quartz Commercial |
$1,658.40
|
| Rate for Payer: WEA Trust Commercial |
$1,520.20
|
| Rate for Payer: WPS Commercial |
$2,047.29
|
|
|
DRILL FREEHAND 4.2 X 130MM IMN 2351-4213S
|
Facility
|
OP
|
$2,764.00
|
|
| Hospital Charge Code |
5599786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.92 |
| Max. Negotiated Rate |
$11,056.00 |
| Rate for Payer: Aetna Commercial |
$2,487.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,377.04
|
| Rate for Payer: Aetna Managed Medicare |
$773.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,796.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,382.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,326.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,464.92
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$2,542.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,546.73
|
| Rate for Payer: Health EOS Commercial |
$2,459.96
|
| Rate for Payer: HFN Commercial |
$2,542.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,073.00
|
| Rate for Payer: Multiplan Commercial |
$2,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,658.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,542.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,354.36
|
| Rate for Payer: Quartz Commercial |
$1,796.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,658.40
|
| Rate for Payer: The Alliance Commercial |
$11,056.00
|
| Rate for Payer: WEA Trust Commercial |
$1,520.20
|
| Rate for Payer: WPS Commercial |
$2,047.29
|
|
|
DRILL FREEHAND 4.2 X 185MM IMN 2351-4218S
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
6151668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
DRILL FREEHAND 4.2 X 185MM IMN 2351-4218S
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
6151668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.76 |
| Max. Negotiated Rate |
$6,768.00 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$473.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,015.20
|
| Rate for Payer: The Alliance Commercial |
$6,768.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
DRILL GUIDE 1.5MTHREADED
|
Facility
|
OP
|
$3,527.00
|
|
| Hospital Charge Code |
2966218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$987.56 |
| Max. Negotiated Rate |
$14,108.00 |
| Rate for Payer: Aetna Commercial |
$3,174.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,033.22
|
| Rate for Payer: Aetna Managed Medicare |
$987.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,292.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,763.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,692.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,869.31
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,244.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,973.71
|
| Rate for Payer: Health EOS Commercial |
$3,139.03
|
| Rate for Payer: HFN Commercial |
$3,244.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,645.25
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,116.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,244.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,728.23
|
| Rate for Payer: Quartz Commercial |
$2,292.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,116.20
|
| Rate for Payer: The Alliance Commercial |
$14,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,939.85
|
| Rate for Payer: WPS Commercial |
$2,612.45
|
|
|
DRILL GUIDE 1.5MTHREADED
|
Facility
|
IP
|
$3,527.00
|
|
| Hospital Charge Code |
2966218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,728.23 |
| Max. Negotiated Rate |
$3,244.84 |
| Rate for Payer: Aetna Commercial |
$3,174.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,033.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,869.31
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,244.84
|
| Rate for Payer: Health EOS Commercial |
$3,139.03
|
| Rate for Payer: HFN Commercial |
$3,244.84
|
| Rate for Payer: Multiplan Commercial |
$2,821.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,116.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,244.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,728.23
|
| Rate for Payer: Quartz Commercial |
$2,116.20
|
| Rate for Payer: WEA Trust Commercial |
$1,939.85
|
| Rate for Payer: WPS Commercial |
$2,612.45
|
|
|
DRILL GUIDE 1.8 SHORT THREAD 323.035
|
Facility
|
IP
|
$1,748.00
|
|
| Hospital Charge Code |
2966607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$856.52 |
| Max. Negotiated Rate |
$1,608.16 |
| Rate for Payer: Aetna Commercial |
$1,573.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,503.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$926.44
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$1,608.16
|
| Rate for Payer: Health EOS Commercial |
$1,555.72
|
| Rate for Payer: HFN Commercial |
$1,608.16
|
| Rate for Payer: Multiplan Commercial |
$1,398.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,048.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,608.16
|
| Rate for Payer: Quartz Beloit One Network |
$856.52
|
| Rate for Payer: Quartz Commercial |
$1,048.80
|
| Rate for Payer: WEA Trust Commercial |
$961.40
|
| Rate for Payer: WPS Commercial |
$1,294.74
|
|
|
DRILL GUIDE 1.8 SHORT THREAD 323.035
|
Facility
|
OP
|
$1,748.00
|
|
| Hospital Charge Code |
2966607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.44 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Aetna Commercial |
$1,573.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,503.28
|
| Rate for Payer: Aetna Managed Medicare |
$489.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,136.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$874.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$839.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$926.44
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$1,608.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$978.18
|
| Rate for Payer: Health EOS Commercial |
$1,555.72
|
| Rate for Payer: HFN Commercial |
$1,608.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,311.00
|
| Rate for Payer: Multiplan Commercial |
$1,398.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,048.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,608.16
|
| Rate for Payer: Quartz Beloit One Network |
$856.52
|
| Rate for Payer: Quartz Commercial |
$1,136.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,048.80
|
| Rate for Payer: The Alliance Commercial |
$6,992.00
|
| Rate for Payer: WEA Trust Commercial |
$961.40
|
| Rate for Payer: WPS Commercial |
$1,294.74
|
|
|
DRILL GUIDE 2.5/1.7MM AR-8916-23
|
Facility
|
OP
|
$4,404.00
|
|
| Hospital Charge Code |
5599763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,233.12 |
| Max. Negotiated Rate |
$17,616.00 |
| Rate for Payer: Aetna Commercial |
$3,963.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,233.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,862.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,113.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.12
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,051.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,464.48
|
| Rate for Payer: Health EOS Commercial |
$3,919.56
|
| Rate for Payer: HFN Commercial |
$4,051.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,303.00
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,642.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,051.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.96
|
| Rate for Payer: Quartz Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,642.40
|
| Rate for Payer: The Alliance Commercial |
$17,616.00
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
|
DRILL GUIDE 2.5/1.7MM AR-8916-23
|
Facility
|
IP
|
$4,404.00
|
|
| Hospital Charge Code |
5599763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,157.96 |
| Max. Negotiated Rate |
$4,051.68 |
| Rate for Payer: Aetna Commercial |
$3,963.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.12
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,051.68
|
| Rate for Payer: Health EOS Commercial |
$3,919.56
|
| Rate for Payer: HFN Commercial |
$4,051.68
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,642.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,051.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.96
|
| Rate for Payer: Quartz Commercial |
$2,642.40
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
