|
DRILL BIT 2.5MM CALIBRATED AR-8943-13
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
4317093
|
|
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 2.5MM CALIBRATED AR-8943-13
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
4317093
|
|
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 2.5MM CANNULATED DSDS0025
|
Facility
|
IP
|
$2,203.00
|
|
| Hospital Charge Code |
6177663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,122.65 |
| Max. Negotiated Rate |
$2,107.83 |
| Rate for Payer: Aetna Commercial |
$2,062.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,970.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.29
|
| Rate for Payer: Cash Price |
$660.90
|
| Rate for Payer: Cigna Commercial |
$2,107.83
|
| Rate for Payer: Health EOS Commercial |
$2,039.10
|
| Rate for Payer: HFN Commercial |
$2,107.83
|
| Rate for Payer: Multiplan Commercial |
$1,832.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,107.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.65
|
| Rate for Payer: Quartz Commercial |
$1,374.67
|
| Rate for Payer: WEA Trust Commercial |
$1,260.12
|
| Rate for Payer: WPS Commercial |
$1,696.97
|
|
|
DRILL BIT 2.5MM CANNULATED DSDS0025
|
Facility
|
OP
|
$2,203.00
|
|
| Hospital Charge Code |
6177663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.51 |
| Max. Negotiated Rate |
$2,107.83 |
| Rate for Payer: Aetna Commercial |
$2,062.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,970.36
|
| Rate for Payer: Aetna Managed Medicare |
$641.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,489.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,145.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,099.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.29
|
| Rate for Payer: Cash Price |
$660.90
|
| Rate for Payer: Cigna Commercial |
$2,107.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,282.15
|
| Rate for Payer: Health EOS Commercial |
$2,039.10
|
| Rate for Payer: HFN Commercial |
$2,107.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,718.34
|
| Rate for Payer: Multiplan Commercial |
$1,832.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,107.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.65
|
| Rate for Payer: Quartz Commercial |
$1,489.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,374.67
|
| Rate for Payer: The Alliance Commercial |
$1,145.56
|
| Rate for Payer: WEA Trust Commercial |
$1,260.12
|
| Rate for Payer: WPS Commercial |
$1,696.97
|
|
|
DRILL BIT 2.5MM GRADUATED & LASER MARKED AR-8943-42
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
5349252
|
|
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 2.5MM GRADUATED & LASER MARKED AR-8943-42
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
5349252
|
|
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 2.5MM X12.7CM 3/32 00-2318-025-06
|
Facility
|
IP
|
$908.00
|
|
| Hospital Charge Code |
2967403
|
|
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 2.5MM X12.7CM 3/32 00-2318-025-06
|
Facility
|
OP
|
$908.00
|
|
| Hospital Charge Code |
2967403
|
|
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 2.5MM X 180MM CALIBRATED TWIST 700351
|
Facility
|
IP
|
$1,467.00
|
|
| Hospital Charge Code |
6198987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.58 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$915.41
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
DRILL BIT 2.5MM X 180MM CALIBRATED TWIST 700351
|
Facility
|
OP
|
$1,467.00
|
|
| Hospital Charge Code |
6198987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.19 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Aetna Managed Medicare |
$427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.79
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,144.26
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: NAPHCARE Commercial |
$915.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$991.69
|
| Rate for Payer: Quartz Medicare Advantage |
$915.41
|
| Rate for Payer: The Alliance Commercial |
$762.84
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
DRILL BIT 2.5MM X 230MM 700355
|
Facility
|
IP
|
$2,068.00
|
|
| Hospital Charge Code |
3983345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,053.85 |
| Max. Negotiated Rate |
$1,978.66 |
| Rate for Payer: Aetna Commercial |
$1,935.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,849.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,139.88
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$1,978.66
|
| Rate for Payer: Health EOS Commercial |
$1,914.14
|
| Rate for Payer: HFN Commercial |
$1,978.66
|
| Rate for Payer: Multiplan Commercial |
$1,720.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,978.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,290.43
|
| Rate for Payer: WEA Trust Commercial |
$1,182.90
|
| Rate for Payer: WPS Commercial |
$1,592.98
|
|
|
DRILL BIT 2.5MM X 230MM 700355
|
Facility
|
OP
|
$2,068.00
|
|
| Hospital Charge Code |
3983345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$602.20 |
| Max. Negotiated Rate |
$1,978.66 |
| Rate for Payer: Aetna Commercial |
$1,935.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,849.62
|
| Rate for Payer: Aetna Managed Medicare |
$602.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,397.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,075.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,032.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,139.88
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$1,978.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,203.58
|
| Rate for Payer: Health EOS Commercial |
$1,914.14
|
| Rate for Payer: HFN Commercial |
$1,978.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,613.04
|
| Rate for Payer: Multiplan Commercial |
$1,720.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,290.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,978.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,397.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,290.43
|
| Rate for Payer: The Alliance Commercial |
$1,075.36
|
| Rate for Payer: WEA Trust Commercial |
$1,182.90
|
| Rate for Payer: WPS Commercial |
$1,592.98
|
|
|
DRILL BIT 2.5 X 110 QUICK COUPLING 310.25
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
2966186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$826.80
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
DRILL BIT 2.5 X 110 QUICK COUPLING 310.25
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
2966186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Aetna Managed Medicare |
$385.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.15
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: NAPHCARE Commercial |
$826.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$895.70
|
| Rate for Payer: Quartz Medicare Advantage |
$826.80
|
| Rate for Payer: The Alliance Commercial |
$689.00
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
DRILL BIT 2.5 X 135 QUICK COUPLE 03.133.102
|
Facility
|
OP
|
$1,736.00
|
|
| Hospital Charge Code |
6180415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.52 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna Commercial |
$1,624.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Aetna Managed Medicare |
$505.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.88
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,661.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.35
|
| Rate for Payer: Health EOS Commercial |
$1,606.84
|
| Rate for Payer: HFN Commercial |
$1,661.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.08
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.00
|
| Rate for Payer: Quartz Beloit One Network |
$884.67
|
| Rate for Payer: Quartz Commercial |
$1,173.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.26
|
| Rate for Payer: The Alliance Commercial |
$902.72
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: WPS Commercial |
$1,337.24
|
|
|
DRILL BIT 2.5 X 135 QUICK COUPLE 03.133.102
|
Facility
|
IP
|
$1,736.00
|
|
| Hospital Charge Code |
6180415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.67 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna Commercial |
$1,624.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.88
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,661.00
|
| Rate for Payer: Health EOS Commercial |
$1,606.84
|
| Rate for Payer: HFN Commercial |
$1,661.00
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.00
|
| Rate for Payer: Quartz Beloit One Network |
$884.67
|
| Rate for Payer: Quartz Commercial |
$1,083.26
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: WPS Commercial |
$1,337.24
|
|
|
DRILL BIT 2.5 X 180 QUICK COUPLE 310.23
|
Facility
|
OP
|
$1,482.00
|
|
| Hospital Charge Code |
2966187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.56 |
| Max. Negotiated Rate |
$1,417.98 |
| Rate for Payer: Aetna Commercial |
$1,387.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,325.50
|
| Rate for Payer: Aetna Managed Medicare |
$431.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,001.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$770.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$739.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.88
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$1,417.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$862.52
|
| Rate for Payer: Health EOS Commercial |
$1,371.74
|
| Rate for Payer: HFN Commercial |
$1,417.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,155.96
|
| Rate for Payer: Multiplan Commercial |
$1,233.02
|
| Rate for Payer: NAPHCARE Commercial |
$924.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.98
|
| Rate for Payer: Quartz Beloit One Network |
$755.23
|
| Rate for Payer: Quartz Commercial |
$1,001.83
|
| Rate for Payer: Quartz Medicare Advantage |
$924.77
|
| Rate for Payer: The Alliance Commercial |
$770.64
|
| Rate for Payer: WEA Trust Commercial |
$847.70
|
| Rate for Payer: WPS Commercial |
$1,141.58
|
|
|
DRILL BIT 2.5 X 180 QUICK COUPLE 310.23
|
Facility
|
IP
|
$1,482.00
|
|
| Hospital Charge Code |
2966187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$755.23 |
| Max. Negotiated Rate |
$1,417.98 |
| Rate for Payer: Aetna Commercial |
$1,387.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,325.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.88
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$1,417.98
|
| Rate for Payer: Health EOS Commercial |
$1,371.74
|
| Rate for Payer: HFN Commercial |
$1,417.98
|
| Rate for Payer: Multiplan Commercial |
$1,233.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.98
|
| Rate for Payer: Quartz Beloit One Network |
$755.23
|
| Rate for Payer: Quartz Commercial |
$924.77
|
| Rate for Payer: WEA Trust Commercial |
$847.70
|
| Rate for Payer: WPS Commercial |
$1,141.58
|
|
|
DRILL BIT 2.5 X 216MM NON- LOCK SHORT 705025
|
Facility
|
IP
|
$1,886.00
|
|
| Hospital Charge Code |
5458924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$961.11 |
| Max. Negotiated Rate |
$1,804.52 |
| Rate for Payer: Aetna Commercial |
$1,765.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,039.56
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,804.52
|
| Rate for Payer: Health EOS Commercial |
$1,745.68
|
| Rate for Payer: HFN Commercial |
$1,804.52
|
| Rate for Payer: Multiplan Commercial |
$1,569.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,804.52
|
| Rate for Payer: Quartz Beloit One Network |
$961.11
|
| Rate for Payer: Quartz Commercial |
$1,176.86
|
| Rate for Payer: WEA Trust Commercial |
$1,078.79
|
| Rate for Payer: WPS Commercial |
$1,452.79
|
|
|
DRILL BIT 2.5 X 216MM NON- LOCK SHORT 705025
|
Facility
|
OP
|
$1,886.00
|
|
| Hospital Charge Code |
5458924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.20 |
| Max. Negotiated Rate |
$1,804.52 |
| Rate for Payer: Aetna Commercial |
$1,765.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.84
|
| Rate for Payer: Aetna Managed Medicare |
$549.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,274.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$980.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$941.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,039.56
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,804.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,097.65
|
| Rate for Payer: Health EOS Commercial |
$1,745.68
|
| Rate for Payer: HFN Commercial |
$1,804.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,471.08
|
| Rate for Payer: Multiplan Commercial |
$1,569.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,176.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,804.52
|
| Rate for Payer: Quartz Beloit One Network |
$961.11
|
| Rate for Payer: Quartz Commercial |
$1,274.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,176.86
|
| Rate for Payer: The Alliance Commercial |
$980.72
|
| Rate for Payer: WEA Trust Commercial |
$1,078.79
|
| Rate for Payer: WPS Commercial |
$1,452.79
|
|
|
DRILL BIT 2.5 X 60MM ORTHOLOC 58850025
|
Facility
|
IP
|
$2,788.00
|
|
| Hospital Charge Code |
5459085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,420.76 |
| Max. Negotiated Rate |
$2,667.56 |
| Rate for Payer: Aetna Commercial |
$2,609.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,493.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,536.75
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$2,667.56
|
| Rate for Payer: Health EOS Commercial |
$2,580.57
|
| Rate for Payer: HFN Commercial |
$2,667.56
|
| Rate for Payer: Multiplan Commercial |
$2,319.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,420.76
|
| Rate for Payer: Quartz Commercial |
$1,739.71
|
| Rate for Payer: WEA Trust Commercial |
$1,594.74
|
| Rate for Payer: WPS Commercial |
$2,147.60
|
|
|
DRILL BIT 2.5 X 60MM ORTHOLOC 58850025
|
Facility
|
OP
|
$2,788.00
|
|
| Hospital Charge Code |
5459085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.87 |
| Max. Negotiated Rate |
$2,667.56 |
| Rate for Payer: Aetna Commercial |
$2,609.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,493.59
|
| Rate for Payer: Aetna Managed Medicare |
$811.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,884.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,449.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,391.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,536.75
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$2,667.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,622.62
|
| Rate for Payer: Health EOS Commercial |
$2,580.57
|
| Rate for Payer: HFN Commercial |
$2,667.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,174.64
|
| Rate for Payer: Multiplan Commercial |
$2,319.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,739.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,420.76
|
| Rate for Payer: Quartz Commercial |
$1,884.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,739.71
|
| Rate for Payer: The Alliance Commercial |
$1,449.76
|
| Rate for Payer: WEA Trust Commercial |
$1,594.74
|
| Rate for Payer: WPS Commercial |
$2,147.60
|
|
|
DRILL BIT 2.5 X 60MM ORTHOLOC 58880025
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5458984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$655.49 |
| Max. Negotiated Rate |
$2,153.76 |
| Rate for Payer: Aetna Commercial |
$2,106.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,013.29
|
| Rate for Payer: Aetna Managed Medicare |
$655.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,521.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,170.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,123.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.75
|
| Rate for Payer: Cash Price |
$675.30
|
| Rate for Payer: Cigna Commercial |
$2,153.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,310.08
|
| Rate for Payer: Health EOS Commercial |
$2,083.53
|
| Rate for Payer: HFN Commercial |
$2,153.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.78
|
| Rate for Payer: Multiplan Commercial |
$1,872.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,153.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.11
|
| Rate for Payer: Quartz Commercial |
$1,521.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.62
|
| Rate for Payer: The Alliance Commercial |
$1,170.52
|
| Rate for Payer: WEA Trust Commercial |
$1,287.57
|
| Rate for Payer: WPS Commercial |
$1,733.95
|
|
|
DRILL BIT 2.5 X 60MM ORTHOLOC 58880025
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5458984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,147.11 |
| Max. Negotiated Rate |
$2,153.76 |
| Rate for Payer: Aetna Commercial |
$2,106.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,013.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.75
|
| Rate for Payer: Cash Price |
$675.30
|
| Rate for Payer: Cigna Commercial |
$2,153.76
|
| Rate for Payer: Health EOS Commercial |
$2,083.53
|
| Rate for Payer: HFN Commercial |
$2,153.76
|
| Rate for Payer: Multiplan Commercial |
$1,872.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,153.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.11
|
| Rate for Payer: Quartz Commercial |
$1,404.62
|
| Rate for Payer: WEA Trust Commercial |
$1,287.57
|
| Rate for Payer: WPS Commercial |
$1,733.95
|
|
|
DRILL BIT 2.6MM CANNULATED AR-8943-02
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5415067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
