|
DRILL TIP GUIDE WIRE 2.5 X 300 03.120.026
|
Facility
|
IP
|
$1,187.00
|
|
| Hospital Charge Code |
2966226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.63 |
| Max. Negotiated Rate |
$1,092.04 |
| Rate for Payer: Aetna Commercial |
$1,068.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.11
|
| Rate for Payer: Cash Price |
$356.10
|
| Rate for Payer: Cigna Commercial |
$1,092.04
|
| Rate for Payer: Health EOS Commercial |
$1,056.43
|
| Rate for Payer: HFN Commercial |
$1,092.04
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: NAPHCARE Commercial |
$712.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.04
|
| Rate for Payer: Quartz Beloit One Network |
$581.63
|
| Rate for Payer: Quartz Commercial |
$712.20
|
| Rate for Payer: WEA Trust Commercial |
$652.85
|
| Rate for Payer: WPS Commercial |
$879.21
|
|
|
DRILL TIP GUIDE WIRE 2.5 X 300 03.120.026
|
Facility
|
OP
|
$1,187.00
|
|
| Hospital Charge Code |
2966226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.36 |
| Max. Negotiated Rate |
$4,748.00 |
| Rate for Payer: Aetna Commercial |
$1,068.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.82
|
| Rate for Payer: Aetna Managed Medicare |
$332.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$771.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$593.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$569.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.11
|
| Rate for Payer: Cash Price |
$356.10
|
| Rate for Payer: Cigna Commercial |
$1,092.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.25
|
| Rate for Payer: Health EOS Commercial |
$1,056.43
|
| Rate for Payer: HFN Commercial |
$1,092.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$890.25
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: NAPHCARE Commercial |
$712.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.04
|
| Rate for Payer: Quartz Beloit One Network |
$581.63
|
| Rate for Payer: Quartz Commercial |
$771.55
|
| Rate for Payer: Quartz Medicare Advantage |
$712.20
|
| Rate for Payer: The Alliance Commercial |
$4,748.00
|
| Rate for Payer: WEA Trust Commercial |
$652.85
|
| Rate for Payer: WPS Commercial |
$879.21
|
|
|
DRILL TWIST CORTICAL OPENER 3.5MM 700353
|
Facility
|
IP
|
$1,402.00
|
|
| Hospital Charge Code |
3983346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.98 |
| Max. Negotiated Rate |
$1,289.84 |
| Rate for Payer: Aetna Commercial |
$1,261.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,205.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.06
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$1,289.84
|
| Rate for Payer: Health EOS Commercial |
$1,247.78
|
| Rate for Payer: HFN Commercial |
$1,289.84
|
| Rate for Payer: Multiplan Commercial |
$1,121.60
|
| Rate for Payer: NAPHCARE Commercial |
$841.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.84
|
| Rate for Payer: Quartz Beloit One Network |
$686.98
|
| Rate for Payer: Quartz Commercial |
$841.20
|
| Rate for Payer: WEA Trust Commercial |
$771.10
|
| Rate for Payer: WPS Commercial |
$1,038.46
|
|
|
DRILL TWIST CORTICAL OPENER 3.5MM 700353
|
Facility
|
OP
|
$1,402.00
|
|
| Hospital Charge Code |
3983346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.56 |
| Max. Negotiated Rate |
$5,608.00 |
| Rate for Payer: Aetna Commercial |
$1,261.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,205.72
|
| Rate for Payer: Aetna Managed Medicare |
$392.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$911.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$701.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.06
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$1,289.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.56
|
| Rate for Payer: Health EOS Commercial |
$1,247.78
|
| Rate for Payer: HFN Commercial |
$1,289.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,051.50
|
| Rate for Payer: Multiplan Commercial |
$1,121.60
|
| Rate for Payer: NAPHCARE Commercial |
$841.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.84
|
| Rate for Payer: Quartz Beloit One Network |
$686.98
|
| Rate for Payer: Quartz Commercial |
$911.30
|
| Rate for Payer: Quartz Medicare Advantage |
$841.20
|
| Rate for Payer: The Alliance Commercial |
$5,608.00
|
| Rate for Payer: WEA Trust Commercial |
$771.10
|
| Rate for Payer: WPS Commercial |
$1,038.46
|
|
|
DRIVER 2.6MM SPADE 214-00-016
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5496695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRIVER 2.6MM SPADE 214-00-016
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5496695
|
|
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
|
|
|
DRIVER 3.4MM SPADE 214-00-009
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5248638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
DRIVER 3.4MM SPADE 214-00-009
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5248638
|
|
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
|
|
|
DRIVER BIT GRIDLOCK 320-35-003
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5459735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
DRIVER BIT GRIDLOCK 320-35-003
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5459735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
DRIVER GRIDLOCK 317-24-003
|
Facility
|
IP
|
$2,585.00
|
|
| Hospital Charge Code |
5547441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
DRIVER GRIDLOCK 317-24-003
|
Facility
|
OP
|
$2,585.00
|
|
| Hospital Charge Code |
5547441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.80 |
| Max. Negotiated Rate |
$10,340.00 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$723.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.57
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.75
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.00
|
| Rate for Payer: The Alliance Commercial |
$10,340.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
DRIVER HIGH TORQUE BIOMET 70-2001
|
Facility
|
IP
|
$2,055.00
|
|
| Hospital Charge Code |
5349383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.95 |
| Max. Negotiated Rate |
$1,890.60 |
| Rate for Payer: Aetna Commercial |
$1,849.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,767.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.15
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,890.60
|
| Rate for Payer: Health EOS Commercial |
$1,828.95
|
| Rate for Payer: HFN Commercial |
$1,890.60
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.95
|
| Rate for Payer: Quartz Commercial |
$1,233.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.25
|
| Rate for Payer: WPS Commercial |
$1,522.14
|
|
|
DRIVER HIGH TORQUE BIOMET 70-2001
|
Facility
|
OP
|
$2,055.00
|
|
| Hospital Charge Code |
5349383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.40 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Aetna Commercial |
$1,849.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,767.30
|
| Rate for Payer: Aetna Managed Medicare |
$575.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.15
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,890.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.98
|
| Rate for Payer: Health EOS Commercial |
$1,828.95
|
| Rate for Payer: HFN Commercial |
$1,890.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,541.25
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.95
|
| Rate for Payer: Quartz Commercial |
$1,335.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.00
|
| Rate for Payer: The Alliance Commercial |
$8,220.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.25
|
| Rate for Payer: WPS Commercial |
$1,522.14
|
|
|
DRIVER MSP T6 MS-DR
|
Facility
|
IP
|
$2,855.00
|
|
| Hospital Charge Code |
5510698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,398.95 |
| Max. Negotiated Rate |
$2,626.60 |
| Rate for Payer: Aetna Commercial |
$2,569.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,455.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,513.15
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$2,626.60
|
| Rate for Payer: Health EOS Commercial |
$2,540.95
|
| Rate for Payer: HFN Commercial |
$2,626.60
|
| Rate for Payer: Multiplan Commercial |
$2,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,713.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,626.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,398.95
|
| Rate for Payer: Quartz Commercial |
$1,713.00
|
| Rate for Payer: WEA Trust Commercial |
$1,570.25
|
| Rate for Payer: WPS Commercial |
$2,114.70
|
|
|
DRIVER MSP T6 MS-DR
|
Facility
|
OP
|
$2,855.00
|
|
| Hospital Charge Code |
5510698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.40 |
| Max. Negotiated Rate |
$11,420.00 |
| Rate for Payer: Aetna Commercial |
$2,569.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,455.30
|
| Rate for Payer: Aetna Managed Medicare |
$799.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,855.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,427.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,370.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,513.15
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$2,626.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,597.66
|
| Rate for Payer: Health EOS Commercial |
$2,540.95
|
| Rate for Payer: HFN Commercial |
$2,626.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,141.25
|
| Rate for Payer: Multiplan Commercial |
$2,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,713.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,626.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,398.95
|
| Rate for Payer: Quartz Commercial |
$1,855.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,713.00
|
| Rate for Payer: The Alliance Commercial |
$11,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,570.25
|
| Rate for Payer: WPS Commercial |
$2,114.70
|
|
|
DRIVER T8 (2.5MM SCREWS) IS1106
|
Facility
|
OP
|
$2,584.00
|
|
| Hospital Charge Code |
5861646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.52 |
| Max. Negotiated Rate |
$10,336.00 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Aetna Managed Medicare |
$723.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,679.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.01
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,679.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,550.40
|
| Rate for Payer: The Alliance Commercial |
$10,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER T8 (2.5MM SCREWS) IS1106
|
Facility
|
IP
|
$2,584.00
|
|
| Hospital Charge Code |
5861646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$2,377.28 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,550.40
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER T9 (3.0MM SCREWS) IS1107
|
Facility
|
IP
|
$2,584.00
|
|
| Hospital Charge Code |
5831691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$2,377.28 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,550.40
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER T9 (3.0MM SCREWS) IS1107
|
Facility
|
OP
|
$2,584.00
|
|
| Hospital Charge Code |
5831691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.52 |
| Max. Negotiated Rate |
$10,336.00 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Aetna Managed Medicare |
$723.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,679.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.01
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,679.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,550.40
|
| Rate for Payer: The Alliance Commercial |
$10,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
DRIVER TIP 2.5MM CANNULATED ACUTRAK HT-1725
|
Facility
|
OP
|
$3,021.00
|
|
| Hospital Charge Code |
4206005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$12,084.00 |
| Rate for Payer: Aetna Commercial |
$2,718.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.06
|
| Rate for Payer: Aetna Managed Medicare |
$845.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,963.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,510.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.13
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,779.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,690.55
|
| Rate for Payer: Health EOS Commercial |
$2,688.69
|
| Rate for Payer: HFN Commercial |
$2,779.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.75
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.29
|
| Rate for Payer: Quartz Commercial |
$1,963.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,812.60
|
| Rate for Payer: The Alliance Commercial |
$12,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,661.55
|
| Rate for Payer: WPS Commercial |
$2,237.65
|
|
|
DRIVER TIP 2.5MM CANNULATED ACUTRAK HT-1725
|
Facility
|
IP
|
$3,021.00
|
|
| Hospital Charge Code |
4206005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.29 |
| Max. Negotiated Rate |
$2,779.32 |
| Rate for Payer: Aetna Commercial |
$2,718.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.13
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,779.32
|
| Rate for Payer: Health EOS Commercial |
$2,688.69
|
| Rate for Payer: HFN Commercial |
$2,779.32
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.29
|
| Rate for Payer: Quartz Commercial |
$1,812.60
|
| Rate for Payer: WEA Trust Commercial |
$1,661.55
|
| Rate for Payer: WPS Commercial |
$2,237.65
|
|
|
DRIVER TIP CANNULATED ACUTRAK 2 HT-1120
|
Facility
|
OP
|
$3,086.00
|
|
| Hospital Charge Code |
3901368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.08 |
| Max. Negotiated Rate |
$12,344.00 |
| Rate for Payer: Aetna Commercial |
$2,777.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,653.96
|
| Rate for Payer: Aetna Managed Medicare |
$864.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,005.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,481.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.58
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,839.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,726.93
|
| Rate for Payer: Health EOS Commercial |
$2,746.54
|
| Rate for Payer: HFN Commercial |
$2,839.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,314.50
|
| Rate for Payer: Multiplan Commercial |
$2,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,851.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.14
|
| Rate for Payer: Quartz Commercial |
$2,005.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,851.60
|
| Rate for Payer: The Alliance Commercial |
$12,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,697.30
|
| Rate for Payer: WPS Commercial |
$2,285.80
|
|
|
DRIVER TIP CANNULATED ACUTRAK 2 HT-1120
|
Facility
|
IP
|
$3,086.00
|
|
| Hospital Charge Code |
3901368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,512.14 |
| Max. Negotiated Rate |
$2,839.12 |
| Rate for Payer: Aetna Commercial |
$2,777.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,653.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.58
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,839.12
|
| Rate for Payer: Health EOS Commercial |
$2,746.54
|
| Rate for Payer: HFN Commercial |
$2,839.12
|
| Rate for Payer: Multiplan Commercial |
$2,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,851.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.14
|
| Rate for Payer: Quartz Commercial |
$1,851.60
|
| Rate for Payer: WEA Trust Commercial |
$1,697.30
|
| Rate for Payer: WPS Commercial |
$2,285.80
|
|
|
DROP DOWN PLUG STEM 5950-67
|
Facility
|
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2967782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.43 |
| Max. Negotiated Rate |
$5,894.44 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,510.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$3,844.20
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
