|
DRILL BIT 1.8 X 110MM WITH DEPTH MARK 310.509
|
Facility
|
IP
|
$2,273.00
|
|
| Hospital Charge Code |
2966177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,158.32 |
| Max. Negotiated Rate |
$2,174.81 |
| Rate for Payer: Aetna Commercial |
$2,127.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,032.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,252.88
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cigna Commercial |
$2,174.81
|
| Rate for Payer: Health EOS Commercial |
$2,103.89
|
| Rate for Payer: HFN Commercial |
$2,174.81
|
| Rate for Payer: Multiplan Commercial |
$1,891.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,174.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,158.32
|
| Rate for Payer: Quartz Commercial |
$1,418.35
|
| Rate for Payer: WEA Trust Commercial |
$1,300.16
|
| Rate for Payer: WPS Commercial |
$1,750.89
|
|
|
DRILL BIT 1.9MM X 27MM 60-19326
|
Facility
|
OP
|
$989.00
|
|
| Hospital Charge Code |
3983365
|
|
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 1.9MM X 27MM 60-19326
|
Facility
|
IP
|
$989.00
|
|
| Hospital Charge Code |
3983365
|
|
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 2.0/2.4 PROXIMAL CORTEX 316-0316
|
Facility
|
IP
|
$2,897.00
|
|
| Hospital Charge Code |
2965445
|
|
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 2.0/2.4 PROXIMAL CORTEX 316-0316
|
Facility
|
OP
|
$2,897.00
|
|
| Hospital Charge Code |
2965445
|
|
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 2.0 ACUMED QUICK COUPLER 80-0317
|
Facility
|
OP
|
$2,266.00
|
|
| Hospital Charge Code |
5459104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.86 |
| Max. Negotiated Rate |
$2,168.11 |
| Rate for Payer: Aetna Commercial |
$2,120.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.71
|
| Rate for Payer: Aetna Managed Medicare |
$659.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,531.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,178.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,131.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,249.02
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$2,168.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,318.81
|
| Rate for Payer: Health EOS Commercial |
$2,097.41
|
| Rate for Payer: HFN Commercial |
$2,168.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,767.48
|
| Rate for Payer: Multiplan Commercial |
$1,885.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,168.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.75
|
| Rate for Payer: Quartz Commercial |
$1,531.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,413.98
|
| Rate for Payer: The Alliance Commercial |
$1,178.32
|
| Rate for Payer: WEA Trust Commercial |
$1,296.15
|
| Rate for Payer: WPS Commercial |
$1,745.50
|
|
|
DRILL BIT 2.0 ACUMED QUICK COUPLER 80-0317
|
Facility
|
IP
|
$2,266.00
|
|
| Hospital Charge Code |
5459104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.75 |
| Max. Negotiated Rate |
$2,168.11 |
| Rate for Payer: Aetna Commercial |
$2,120.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,249.02
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$2,168.11
|
| Rate for Payer: Health EOS Commercial |
$2,097.41
|
| Rate for Payer: HFN Commercial |
$2,168.11
|
| Rate for Payer: Multiplan Commercial |
$1,885.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,168.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.75
|
| Rate for Payer: Quartz Commercial |
$1,413.98
|
| Rate for Payer: WEA Trust Commercial |
$1,296.15
|
| Rate for Payer: WPS Commercial |
$1,745.50
|
|
|
DRILL BIT 2.0 (AO) AR-8944-22
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
5459676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.16 |
| Max. Negotiated Rate |
$1,298.38 |
| Rate for Payer: Aetna Commercial |
$1,270.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,213.70
|
| Rate for Payer: Aetna Managed Medicare |
$395.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$917.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$705.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$677.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.98
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,298.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$789.77
|
| Rate for Payer: Health EOS Commercial |
$1,256.04
|
| Rate for Payer: HFN Commercial |
$1,298.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,058.46
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: NAPHCARE Commercial |
$846.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,298.38
|
| Rate for Payer: Quartz Beloit One Network |
$691.53
|
| Rate for Payer: Quartz Commercial |
$917.33
|
| Rate for Payer: Quartz Medicare Advantage |
$846.77
|
| Rate for Payer: The Alliance Commercial |
$705.64
|
| Rate for Payer: WEA Trust Commercial |
$776.20
|
| Rate for Payer: WPS Commercial |
$1,045.30
|
|
|
DRILL BIT 2.0 (AO) AR-8944-22
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
5459676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$691.53 |
| Max. Negotiated Rate |
$1,298.38 |
| Rate for Payer: Aetna Commercial |
$1,270.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,213.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.98
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,298.38
|
| Rate for Payer: Health EOS Commercial |
$1,256.04
|
| Rate for Payer: HFN Commercial |
$1,298.38
|
| Rate for Payer: Multiplan Commercial |
$1,129.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,298.38
|
| Rate for Payer: Quartz Beloit One Network |
$691.53
|
| Rate for Payer: Quartz Commercial |
$846.77
|
| Rate for Payer: WEA Trust Commercial |
$776.20
|
| Rate for Payer: WPS Commercial |
$1,045.30
|
|
|
DRILL BIT 2.0MM CALIBRATED AR-8943-16
|
Facility
|
OP
|
$1,517.00
|
|
| Hospital Charge Code |
4509013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.75 |
| Max. Negotiated Rate |
$1,451.47 |
| Rate for Payer: Aetna Commercial |
$1,419.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,356.80
|
| Rate for Payer: Aetna Managed Medicare |
$441.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,025.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$788.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$757.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.17
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,451.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$882.89
|
| Rate for Payer: Health EOS Commercial |
$1,404.14
|
| Rate for Payer: HFN Commercial |
$1,451.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,183.26
|
| Rate for Payer: Multiplan Commercial |
$1,262.14
|
| Rate for Payer: NAPHCARE Commercial |
$946.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,451.47
|
| Rate for Payer: Quartz Beloit One Network |
$773.06
|
| Rate for Payer: Quartz Commercial |
$1,025.49
|
| Rate for Payer: Quartz Medicare Advantage |
$946.61
|
| Rate for Payer: The Alliance Commercial |
$788.84
|
| Rate for Payer: WEA Trust Commercial |
$867.72
|
| Rate for Payer: WPS Commercial |
$1,168.55
|
|
|
DRILL BIT 2.0MM CALIBRATED AR-8943-16
|
Facility
|
IP
|
$1,517.00
|
|
| Hospital Charge Code |
4509013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.06 |
| Max. Negotiated Rate |
$1,451.47 |
| Rate for Payer: Aetna Commercial |
$1,419.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,356.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.17
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,451.47
|
| Rate for Payer: Health EOS Commercial |
$1,404.14
|
| Rate for Payer: HFN Commercial |
$1,451.47
|
| Rate for Payer: Multiplan Commercial |
$1,262.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,451.47
|
| Rate for Payer: Quartz Beloit One Network |
$773.06
|
| Rate for Payer: Quartz Commercial |
$946.61
|
| Rate for Payer: WEA Trust Commercial |
$867.72
|
| Rate for Payer: WPS Commercial |
$1,168.55
|
|
|
DRILL BIT 2.0MM CMP FT CALIBRATED AR-8737-34
|
Facility
|
IP
|
$2,596.00
|
|
| Hospital Charge Code |
5547456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,322.92 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,619.90
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
DRILL BIT 2.0MM CMP FT CALIBRATED AR-8737-34
|
Facility
|
OP
|
$2,596.00
|
|
| Hospital Charge Code |
5547456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$755.96 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Aetna Managed Medicare |
$755.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,754.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,349.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,295.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,510.87
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.88
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,754.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,619.90
|
| Rate for Payer: The Alliance Commercial |
$1,349.92
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
DRILL BIT 2.0MM QUICKFIX AR-8930D-13
|
Facility
|
IP
|
$1,531.00
|
|
| Hospital Charge Code |
5415011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$955.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
DRILL BIT 2.0MM QUICKFIX AR-8930D-13
|
Facility
|
OP
|
$1,531.00
|
|
| Hospital Charge Code |
5415011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.83 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$445.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,034.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.04
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.18
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$955.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$1,034.96
|
| Rate for Payer: Quartz Medicare Advantage |
$955.34
|
| Rate for Payer: The Alliance Commercial |
$796.12
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
DRILL BIT 2.0MM X 105MM AO SCALED STRYKER 705134
|
Facility
|
OP
|
$2,248.00
|
|
| Hospital Charge Code |
5685724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$654.62 |
| Max. Negotiated Rate |
$2,150.89 |
| Rate for Payer: Aetna Commercial |
$2,104.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,010.61
|
| Rate for Payer: Aetna Managed Medicare |
$654.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,519.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,168.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,122.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,239.10
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,150.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,308.34
|
| Rate for Payer: Health EOS Commercial |
$2,080.75
|
| Rate for Payer: HFN Commercial |
$2,150.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,753.44
|
| Rate for Payer: Multiplan Commercial |
$1,870.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,402.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,150.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.58
|
| Rate for Payer: Quartz Commercial |
$1,519.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,402.75
|
| Rate for Payer: The Alliance Commercial |
$1,168.96
|
| Rate for Payer: WEA Trust Commercial |
$1,285.86
|
| Rate for Payer: WPS Commercial |
$1,731.63
|
|
|
DRILL BIT 2.0MM X 105MM AO SCALED STRYKER 705134
|
Facility
|
IP
|
$2,248.00
|
|
| Hospital Charge Code |
5685724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,145.58 |
| Max. Negotiated Rate |
$2,150.89 |
| Rate for Payer: Aetna Commercial |
$2,104.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,010.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,239.10
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,150.89
|
| Rate for Payer: Health EOS Commercial |
$2,080.75
|
| Rate for Payer: HFN Commercial |
$2,150.89
|
| Rate for Payer: Multiplan Commercial |
$1,870.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,150.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.58
|
| Rate for Payer: Quartz Commercial |
$1,402.75
|
| Rate for Payer: WEA Trust Commercial |
$1,285.86
|
| Rate for Payer: WPS Commercial |
$1,731.63
|
|
|
DRILL BIT 2.0MM X12.7CM 5/64 00-2318-020-06
|
Facility
|
OP
|
$908.00
|
|
| Hospital Charge Code |
2967402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.41 |
| Max. Negotiated Rate |
$868.77 |
| Rate for Payer: Aetna Commercial |
$849.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.12
|
| Rate for Payer: Aetna Managed Medicare |
$264.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$613.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.49
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$868.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.46
|
| Rate for Payer: Health EOS Commercial |
$840.44
|
| Rate for Payer: HFN Commercial |
$868.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$708.24
|
| Rate for Payer: Multiplan Commercial |
$755.46
|
| Rate for Payer: NAPHCARE Commercial |
$566.59
|
| Rate for Payer: Preferred Network Access Commercial |
$868.77
|
| Rate for Payer: Quartz Beloit One Network |
$462.72
|
| Rate for Payer: Quartz Commercial |
$613.81
|
| Rate for Payer: Quartz Medicare Advantage |
$566.59
|
| Rate for Payer: The Alliance Commercial |
$472.16
|
| Rate for Payer: WEA Trust Commercial |
$519.38
|
| Rate for Payer: WPS Commercial |
$699.43
|
|
|
DRILL BIT 2.0MM X12.7CM 5/64 00-2318-020-06
|
Facility
|
IP
|
$908.00
|
|
| Hospital Charge Code |
2967402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.72 |
| Max. Negotiated Rate |
$868.77 |
| Rate for Payer: Aetna Commercial |
$849.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.49
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$868.77
|
| Rate for Payer: Health EOS Commercial |
$840.44
|
| Rate for Payer: HFN Commercial |
$868.77
|
| Rate for Payer: Multiplan Commercial |
$755.46
|
| Rate for Payer: Preferred Network Access Commercial |
$868.77
|
| Rate for Payer: Quartz Beloit One Network |
$462.72
|
| Rate for Payer: Quartz Commercial |
$566.59
|
| Rate for Payer: WEA Trust Commercial |
$519.38
|
| Rate for Payer: WPS Commercial |
$699.43
|
|
|
DRILL BIT 2.0MM X 135MM AO COUPLING STRYKER 703690
|
Facility
|
IP
|
$2,794.00
|
|
| Hospital Charge Code |
5415595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,423.82 |
| Max. Negotiated Rate |
$2,673.30 |
| Rate for Payer: Aetna Commercial |
$2,615.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,540.05
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$2,673.30
|
| Rate for Payer: Health EOS Commercial |
$2,586.13
|
| Rate for Payer: HFN Commercial |
$2,673.30
|
| Rate for Payer: Multiplan Commercial |
$2,324.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,673.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.82
|
| Rate for Payer: Quartz Commercial |
$1,743.46
|
| Rate for Payer: WEA Trust Commercial |
$1,598.17
|
| Rate for Payer: WPS Commercial |
$2,152.22
|
|
|
DRILL BIT 2.0MM X 135MM AO COUPLING STRYKER 703690
|
Facility
|
OP
|
$2,794.00
|
|
| Hospital Charge Code |
5415595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$813.61 |
| Max. Negotiated Rate |
$2,673.30 |
| Rate for Payer: Aetna Commercial |
$2,615.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.95
|
| Rate for Payer: Aetna Managed Medicare |
$813.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,888.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,452.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,394.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,540.05
|
| Rate for Payer: Cash Price |
$838.20
|
| Rate for Payer: Cigna Commercial |
$2,673.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,626.11
|
| Rate for Payer: Health EOS Commercial |
$2,586.13
|
| Rate for Payer: HFN Commercial |
$2,673.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,179.32
|
| Rate for Payer: Multiplan Commercial |
$2,324.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,743.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,673.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.82
|
| Rate for Payer: Quartz Commercial |
$1,888.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,743.46
|
| Rate for Payer: The Alliance Commercial |
$1,452.88
|
| Rate for Payer: WEA Trust Commercial |
$1,598.17
|
| Rate for Payer: WPS Commercial |
$2,152.22
|
|
|
DRILL BIT 2.0MM X 135MM SCALED STRYKER 703896
|
Facility
|
OP
|
$1,346.00
|
|
| Hospital Charge Code |
5458927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.96 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Aetna Managed Medicare |
$391.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.37
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.88
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: NAPHCARE Commercial |
$839.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$909.90
|
| Rate for Payer: Quartz Medicare Advantage |
$839.90
|
| Rate for Payer: The Alliance Commercial |
$699.92
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
DRILL BIT 2.0MM X 135MM SCALED STRYKER 703896
|
Facility
|
IP
|
$1,346.00
|
|
| Hospital Charge Code |
5458927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.92 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$839.90
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
DRILL BIT 2.0MM X 30MM 58820025
|
Facility
|
IP
|
$2,582.00
|
|
| Hospital Charge Code |
6089648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,315.79 |
| Max. Negotiated Rate |
$2,470.46 |
| Rate for Payer: Aetna Commercial |
$2,416.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.20
|
| Rate for Payer: Cash Price |
$774.60
|
| Rate for Payer: Cigna Commercial |
$2,470.46
|
| Rate for Payer: Health EOS Commercial |
$2,389.90
|
| Rate for Payer: HFN Commercial |
$2,470.46
|
| Rate for Payer: Multiplan Commercial |
$2,148.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,470.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.79
|
| Rate for Payer: Quartz Commercial |
$1,611.17
|
| Rate for Payer: WEA Trust Commercial |
$1,476.90
|
| Rate for Payer: WPS Commercial |
$1,988.91
|
|
|
DRILL BIT 2.0MM X 30MM 58820025
|
Facility
|
OP
|
$2,582.00
|
|
| Hospital Charge Code |
6089648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.88 |
| Max. Negotiated Rate |
$2,470.46 |
| Rate for Payer: Aetna Commercial |
$2,416.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,309.34
|
| Rate for Payer: Aetna Managed Medicare |
$751.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,745.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,342.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,288.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.20
|
| Rate for Payer: Cash Price |
$774.60
|
| Rate for Payer: Cigna Commercial |
$2,470.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,502.72
|
| Rate for Payer: Health EOS Commercial |
$2,389.90
|
| Rate for Payer: HFN Commercial |
$2,470.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,013.96
|
| Rate for Payer: Multiplan Commercial |
$2,148.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,470.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.79
|
| Rate for Payer: Quartz Commercial |
$1,745.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.17
|
| Rate for Payer: The Alliance Commercial |
$1,342.64
|
| Rate for Payer: WEA Trust Commercial |
$1,476.90
|
| Rate for Payer: WPS Commercial |
$1,988.91
|
|
