|
DRILL GUIDE INTERFRAF M.I.B. 317-00-005
|
Facility
|
IP
|
$2,516.00
|
|
| Hospital Charge Code |
5506863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,232.84 |
| Max. Negotiated Rate |
$2,314.72 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,509.60
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
DRILL GUIDE INTERFRAF M.I.B. 317-00-005
|
Facility
|
OP
|
$2,516.00
|
|
| Hospital Charge Code |
5506863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.48 |
| Max. Negotiated Rate |
$10,064.00 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Aetna Managed Medicare |
$704.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,635.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.95
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,887.00
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,635.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,509.60
|
| Rate for Payer: The Alliance Commercial |
$10,064.00
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
DRILL GUIDE PULL REDUCTION DEVICE 4.3 PERC 03.120.023
|
Facility
|
OP
|
$4,804.00
|
|
| Hospital Charge Code |
3072544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,345.12 |
| Max. Negotiated Rate |
$19,216.00 |
| Rate for Payer: Aetna Commercial |
$4,323.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,131.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,345.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,122.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,402.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.12
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$4,419.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,688.32
|
| Rate for Payer: Health EOS Commercial |
$4,275.56
|
| Rate for Payer: HFN Commercial |
$4,419.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,603.00
|
| Rate for Payer: Multiplan Commercial |
$3,843.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,419.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.96
|
| Rate for Payer: Quartz Commercial |
$3,122.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,882.40
|
| Rate for Payer: The Alliance Commercial |
$19,216.00
|
| Rate for Payer: WEA Trust Commercial |
$2,642.20
|
| Rate for Payer: WPS Commercial |
$3,558.32
|
|
|
DRILL GUIDE PULL REDUCTION DEVICE 4.3 PERC 03.120.023
|
Facility
|
IP
|
$4,804.00
|
|
| Hospital Charge Code |
3072544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,353.96 |
| Max. Negotiated Rate |
$4,419.68 |
| Rate for Payer: Aetna Commercial |
$4,323.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,131.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.12
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$4,419.68
|
| Rate for Payer: Health EOS Commercial |
$4,275.56
|
| Rate for Payer: HFN Commercial |
$4,419.68
|
| Rate for Payer: Multiplan Commercial |
$3,843.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,419.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.96
|
| Rate for Payer: Quartz Commercial |
$2,882.40
|
| Rate for Payer: WEA Trust Commercial |
$2,642.20
|
| Rate for Payer: WPS Commercial |
$3,558.32
|
|
|
DRILL GUIDE THREADED M.I.B. 317-00-004
|
Facility
|
IP
|
$2,516.00
|
|
| Hospital Charge Code |
5506861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,232.84 |
| Max. Negotiated Rate |
$2,314.72 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,509.60
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
DRILL GUIDE THREADED M.I.B. 317-00-004
|
Facility
|
OP
|
$2,516.00
|
|
| Hospital Charge Code |
5506861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.48 |
| Max. Negotiated Rate |
$10,064.00 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Aetna Managed Medicare |
$704.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,635.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.95
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,887.00
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,635.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,509.60
|
| Rate for Payer: The Alliance Commercial |
$10,064.00
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
DRILL KIT ERGO GPS 3.2MM STERILE 531-55-88
|
Facility
|
IP
|
$2,500.70
|
|
| Hospital Charge Code |
6248149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,225.34 |
| Max. Negotiated Rate |
$2,300.64 |
| Rate for Payer: Aetna Commercial |
$2,250.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,150.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,325.37
|
| Rate for Payer: Cash Price |
$750.21
|
| Rate for Payer: Cigna Commercial |
$2,300.64
|
| Rate for Payer: Health EOS Commercial |
$2,225.62
|
| Rate for Payer: HFN Commercial |
$2,300.64
|
| Rate for Payer: Multiplan Commercial |
$2,000.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,500.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,300.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.34
|
| Rate for Payer: Quartz Commercial |
$1,500.42
|
| Rate for Payer: WEA Trust Commercial |
$1,375.38
|
| Rate for Payer: WPS Commercial |
$1,852.27
|
|
|
DRILL KIT ERGO GPS 3.2MM STERILE 531-55-88
|
Facility
|
OP
|
$2,500.70
|
|
| Hospital Charge Code |
6248149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.20 |
| Max. Negotiated Rate |
$10,002.80 |
| Rate for Payer: Aetna Commercial |
$2,250.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,150.60
|
| Rate for Payer: Aetna Managed Medicare |
$700.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,625.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,250.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,200.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,325.37
|
| Rate for Payer: Cash Price |
$750.21
|
| Rate for Payer: Cigna Commercial |
$2,300.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,399.39
|
| Rate for Payer: Health EOS Commercial |
$2,225.62
|
| Rate for Payer: HFN Commercial |
$2,300.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,875.52
|
| Rate for Payer: Multiplan Commercial |
$2,000.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,500.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,300.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.34
|
| Rate for Payer: Quartz Commercial |
$1,625.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,500.42
|
| Rate for Payer: The Alliance Commercial |
$10,002.80
|
| Rate for Payer: WEA Trust Commercial |
$1,375.38
|
| Rate for Payer: WPS Commercial |
$1,852.27
|
|
|
DRILL LOCKING 4.2 X 360MM IMN 2351-4236S
|
Facility
|
OP
|
$3,030.00
|
|
| Hospital Charge Code |
5599784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$848.40 |
| Max. Negotiated Rate |
$12,120.00 |
| Rate for Payer: Aetna Commercial |
$2,727.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,605.80
|
| Rate for Payer: Aetna Managed Medicare |
$848.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,969.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,515.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,454.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.90
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,787.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,695.59
|
| Rate for Payer: Health EOS Commercial |
$2,696.70
|
| Rate for Payer: HFN Commercial |
$2,787.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,272.50
|
| Rate for Payer: Multiplan Commercial |
$2,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,818.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,787.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,484.70
|
| Rate for Payer: Quartz Commercial |
$1,969.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,818.00
|
| Rate for Payer: The Alliance Commercial |
$12,120.00
|
| Rate for Payer: WEA Trust Commercial |
$1,666.50
|
| Rate for Payer: WPS Commercial |
$2,244.32
|
|
|
DRILL LOCKING 4.2 X 360MM IMN 2351-4236S
|
Facility
|
IP
|
$3,030.00
|
|
| Hospital Charge Code |
5599784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,484.70 |
| Max. Negotiated Rate |
$2,787.60 |
| Rate for Payer: Aetna Commercial |
$2,727.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,605.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.90
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,787.60
|
| Rate for Payer: Health EOS Commercial |
$2,696.70
|
| Rate for Payer: HFN Commercial |
$2,787.60
|
| Rate for Payer: Multiplan Commercial |
$2,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,818.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,787.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,484.70
|
| Rate for Payer: Quartz Commercial |
$1,818.00
|
| Rate for Payer: WEA Trust Commercial |
$1,666.50
|
| Rate for Payer: WPS Commercial |
$2,244.32
|
|
|
DRILL LONG MINI
|
Facility
|
IP
|
$2,758.00
|
|
| Hospital Charge Code |
2967894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,351.42 |
| Max. Negotiated Rate |
$2,537.36 |
| Rate for Payer: Aetna Commercial |
$2,482.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,371.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,461.74
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,537.36
|
| Rate for Payer: Health EOS Commercial |
$2,454.62
|
| Rate for Payer: HFN Commercial |
$2,537.36
|
| Rate for Payer: Multiplan Commercial |
$2,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,654.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,537.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,351.42
|
| Rate for Payer: Quartz Commercial |
$1,654.80
|
| Rate for Payer: WEA Trust Commercial |
$1,516.90
|
| Rate for Payer: WPS Commercial |
$2,042.85
|
|
|
DRILL LONG MINI
|
Facility
|
OP
|
$2,758.00
|
|
| Hospital Charge Code |
2967894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.24 |
| Max. Negotiated Rate |
$11,032.00 |
| Rate for Payer: Aetna Commercial |
$2,482.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,371.88
|
| Rate for Payer: Aetna Managed Medicare |
$772.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,792.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,323.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,461.74
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,537.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,543.38
|
| Rate for Payer: Health EOS Commercial |
$2,454.62
|
| Rate for Payer: HFN Commercial |
$2,537.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,068.50
|
| Rate for Payer: Multiplan Commercial |
$2,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,654.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,537.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,351.42
|
| Rate for Payer: Quartz Commercial |
$1,792.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,654.80
|
| Rate for Payer: The Alliance Commercial |
$11,032.00
|
| Rate for Payer: WEA Trust Commercial |
$1,516.90
|
| Rate for Payer: WPS Commercial |
$2,042.85
|
|
|
DRILL MICRO ACUTRAK 2 AT2-1509
|
Facility
|
IP
|
$3,386.00
|
|
| Hospital Charge Code |
2964141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,659.14 |
| Max. Negotiated Rate |
$3,115.12 |
| Rate for Payer: Aetna Commercial |
$3,047.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,911.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,794.58
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,115.12
|
| Rate for Payer: Health EOS Commercial |
$3,013.54
|
| Rate for Payer: HFN Commercial |
$3,115.12
|
| Rate for Payer: Multiplan Commercial |
$2,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,031.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,115.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,659.14
|
| Rate for Payer: Quartz Commercial |
$2,031.60
|
| Rate for Payer: WEA Trust Commercial |
$1,862.30
|
| Rate for Payer: WPS Commercial |
$2,508.01
|
|
|
DRILL MICRO ACUTRAK 2 AT2-1509
|
Facility
|
OP
|
$3,386.00
|
|
| Hospital Charge Code |
2964141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$948.08 |
| Max. Negotiated Rate |
$13,544.00 |
| Rate for Payer: Aetna Commercial |
$3,047.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,911.96
|
| Rate for Payer: Aetna Managed Medicare |
$948.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,200.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,693.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,625.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,794.58
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,115.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,894.81
|
| Rate for Payer: Health EOS Commercial |
$3,013.54
|
| Rate for Payer: HFN Commercial |
$3,115.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,539.50
|
| Rate for Payer: Multiplan Commercial |
$2,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,031.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,115.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,659.14
|
| Rate for Payer: Quartz Commercial |
$2,200.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,031.60
|
| Rate for Payer: The Alliance Commercial |
$13,544.00
|
| Rate for Payer: WEA Trust Commercial |
$1,862.30
|
| Rate for Payer: WPS Commercial |
$2,508.01
|
|
|
DRILL MICRO EXTENDED LONG ACUTRAK 2 80-1522
|
Facility
|
IP
|
$4,521.00
|
|
| Hospital Charge Code |
5603708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,215.29 |
| Max. Negotiated Rate |
$4,159.32 |
| Rate for Payer: Aetna Commercial |
$4,068.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,888.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,159.32
|
| Rate for Payer: Health EOS Commercial |
$4,023.69
|
| Rate for Payer: HFN Commercial |
$4,159.32
|
| Rate for Payer: Multiplan Commercial |
$3,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,712.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,159.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.29
|
| Rate for Payer: Quartz Commercial |
$2,712.60
|
| Rate for Payer: WEA Trust Commercial |
$2,486.55
|
| Rate for Payer: WPS Commercial |
$3,348.70
|
|
|
DRILL MICRO EXTENDED LONG ACUTRAK 2 80-1522
|
Facility
|
OP
|
$4,521.00
|
|
| Hospital Charge Code |
5603708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$18,084.00 |
| Rate for Payer: Aetna Commercial |
$4,068.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,888.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,938.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,170.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,159.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.95
|
| Rate for Payer: Health EOS Commercial |
$4,023.69
|
| Rate for Payer: HFN Commercial |
$4,159.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,390.75
|
| Rate for Payer: Multiplan Commercial |
$3,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,712.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,159.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.29
|
| Rate for Payer: Quartz Commercial |
$2,938.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,712.60
|
| Rate for Payer: The Alliance Commercial |
$18,084.00
|
| Rate for Payer: WEA Trust Commercial |
$2,486.55
|
| Rate for Payer: WPS Commercial |
$3,348.70
|
|
|
DRILL MICRO LONG
|
Facility
|
IP
|
$5,950.00
|
|
| Hospital Charge Code |
2967891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,915.50 |
| Max. Negotiated Rate |
$5,474.00 |
| Rate for Payer: Aetna Commercial |
$5,355.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,117.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.50
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$5,474.00
|
| Rate for Payer: Health EOS Commercial |
$5,295.50
|
| Rate for Payer: HFN Commercial |
$5,474.00
|
| Rate for Payer: Multiplan Commercial |
$4,760.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,570.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,474.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.50
|
| Rate for Payer: Quartz Commercial |
$3,570.00
|
| Rate for Payer: WEA Trust Commercial |
$3,272.50
|
| Rate for Payer: WPS Commercial |
$4,407.16
|
|
|
DRILL MICRO LONG
|
Facility
|
OP
|
$5,950.00
|
|
| Hospital Charge Code |
2967891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,666.00 |
| Max. Negotiated Rate |
$23,800.00 |
| Rate for Payer: Aetna Commercial |
$5,355.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,117.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,666.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,867.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,856.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.50
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$5,474.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,329.62
|
| Rate for Payer: Health EOS Commercial |
$5,295.50
|
| Rate for Payer: HFN Commercial |
$5,474.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,462.50
|
| Rate for Payer: Multiplan Commercial |
$4,760.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,570.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,474.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.50
|
| Rate for Payer: Quartz Commercial |
$3,867.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,570.00
|
| Rate for Payer: The Alliance Commercial |
$23,800.00
|
| Rate for Payer: WEA Trust Commercial |
$3,272.50
|
| Rate for Payer: WPS Commercial |
$4,407.16
|
|
|
DRILL MINI PROFILE
|
Facility
|
IP
|
$2,733.00
|
|
| Hospital Charge Code |
2964142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,339.17 |
| Max. Negotiated Rate |
$2,514.36 |
| Rate for Payer: Aetna Commercial |
$2,459.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,350.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,448.49
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna Commercial |
$2,514.36
|
| Rate for Payer: Health EOS Commercial |
$2,432.37
|
| Rate for Payer: HFN Commercial |
$2,514.36
|
| Rate for Payer: Multiplan Commercial |
$2,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,639.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,514.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,339.17
|
| Rate for Payer: Quartz Commercial |
$1,639.80
|
| Rate for Payer: WEA Trust Commercial |
$1,503.15
|
| Rate for Payer: WPS Commercial |
$2,024.33
|
|
|
DRILL MINI PROFILE
|
Facility
|
OP
|
$2,733.00
|
|
| Hospital Charge Code |
2964142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.24 |
| Max. Negotiated Rate |
$10,932.00 |
| Rate for Payer: Aetna Commercial |
$2,459.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,350.38
|
| Rate for Payer: Aetna Managed Medicare |
$765.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,776.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,366.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,311.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,448.49
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna Commercial |
$2,514.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,529.39
|
| Rate for Payer: Health EOS Commercial |
$2,432.37
|
| Rate for Payer: HFN Commercial |
$2,514.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,049.75
|
| Rate for Payer: Multiplan Commercial |
$2,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,639.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,514.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,339.17
|
| Rate for Payer: Quartz Commercial |
$1,776.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,639.80
|
| Rate for Payer: The Alliance Commercial |
$10,932.00
|
| Rate for Payer: WEA Trust Commercial |
$1,503.15
|
| Rate for Payer: WPS Commercial |
$2,024.33
|
|
|
DRILL PILOT 2.0 510-20-002
|
Facility
|
OP
|
$2,394.00
|
|
| Hospital Charge Code |
5563330
|
|
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 PILOT 2.0 510-20-002
|
Facility
|
IP
|
$2,394.00
|
|
| Hospital Charge Code |
5563330
|
|
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 PIN BICEPS BUTTON 3.2MM AR-2263
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,034.88 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,267.20
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
DRILL PIN BICEPS BUTTON 3.2MM AR-2263
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Aetna Managed Medicare |
$591.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.88
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.20
|
| Rate for Payer: The Alliance Commercial |
$8,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
DRILL PIN HEADLESS TROCAR 00-5901-020-00
|
Facility
|
IP
|
$4,331.00
|
|
| Hospital Charge Code |
3110200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,122.19 |
| Max. Negotiated Rate |
$3,984.52 |
| Rate for Payer: Aetna Commercial |
$3,897.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,724.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,295.43
|
| Rate for Payer: Cash Price |
$1,299.30
|
| Rate for Payer: Cigna Commercial |
$3,984.52
|
| Rate for Payer: Health EOS Commercial |
$3,854.59
|
| Rate for Payer: HFN Commercial |
$3,984.52
|
| Rate for Payer: Multiplan Commercial |
$3,464.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,984.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,122.19
|
| Rate for Payer: Quartz Commercial |
$2,598.60
|
| Rate for Payer: WEA Trust Commercial |
$2,382.05
|
| Rate for Payer: WPS Commercial |
$3,207.97
|
|
