|
DRILL BIT 1.5MM X 74MM (MINI QUICK COUPLING FOR THREADED HOLE) 03.130.302
|
Facility
|
OP
|
$1,340.00
|
|
| Hospital Charge Code |
6181464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.21 |
| Max. Negotiated Rate |
$1,282.11 |
| Rate for Payer: Aetna Commercial |
$1,254.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,198.50
|
| Rate for Payer: Aetna Managed Medicare |
$390.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$905.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$696.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$668.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$738.61
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,282.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$779.88
|
| Rate for Payer: Health EOS Commercial |
$1,240.30
|
| Rate for Payer: HFN Commercial |
$1,282.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,045.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.88
|
| Rate for Payer: NAPHCARE Commercial |
$836.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.11
|
| Rate for Payer: Quartz Beloit One Network |
$682.86
|
| Rate for Payer: Quartz Commercial |
$905.84
|
| Rate for Payer: Quartz Medicare Advantage |
$836.16
|
| Rate for Payer: The Alliance Commercial |
$696.80
|
| Rate for Payer: WEA Trust Commercial |
$766.48
|
| Rate for Payer: WPS Commercial |
$1,032.20
|
|
|
DRILL BIT 1.5MM X 74MM (MINI QUICK COUPLING FOR THREADED HOLE) 03.130.302
|
Facility
|
IP
|
$1,340.00
|
|
| Hospital Charge Code |
6181464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.86 |
| Max. Negotiated Rate |
$1,282.11 |
| Rate for Payer: Aetna Commercial |
$1,254.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$738.61
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,282.11
|
| Rate for Payer: Health EOS Commercial |
$1,240.30
|
| Rate for Payer: HFN Commercial |
$1,282.11
|
| Rate for Payer: Multiplan Commercial |
$1,114.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.11
|
| Rate for Payer: Quartz Beloit One Network |
$682.86
|
| Rate for Payer: Quartz Commercial |
$836.16
|
| Rate for Payer: WEA Trust Commercial |
$766.48
|
| Rate for Payer: WPS Commercial |
$1,032.20
|
|
|
DRILL BIT 1.5MM X 83MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.301
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.39 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$838.03
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
DRILL BIT 1.5MM X 83MM (STRYKER J-LATCH FOR THREADED HOLE) 03.130.301
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.08 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Aetna Managed Medicare |
$391.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$698.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$670.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.63
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,047.54
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: NAPHCARE Commercial |
$838.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$907.87
|
| Rate for Payer: Quartz Medicare Advantage |
$838.03
|
| Rate for Payer: The Alliance Commercial |
$698.36
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
DRILL BIT 1.5MM X 85MM QUICK COUPLE 310.15
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
5074874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
DRILL BIT 1.5MM X 85MM QUICK COUPLE 310.15
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
5074874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
DRILL BIT 1.5 X 96MM MINI QUICK COUPLER DEPTH MARKER 310.507
|
Facility
|
OP
|
$2,349.00
|
|
| Hospital Charge Code |
2966175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$684.03 |
| Max. Negotiated Rate |
$2,247.52 |
| Rate for Payer: Aetna Commercial |
$2,198.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.95
|
| Rate for Payer: Aetna Managed Medicare |
$684.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,587.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,221.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,294.77
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,247.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,367.12
|
| Rate for Payer: Health EOS Commercial |
$2,174.23
|
| Rate for Payer: HFN Commercial |
$2,247.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,832.22
|
| Rate for Payer: Multiplan Commercial |
$1,954.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,465.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,247.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.05
|
| Rate for Payer: Quartz Commercial |
$1,587.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,465.78
|
| Rate for Payer: The Alliance Commercial |
$1,221.48
|
| Rate for Payer: WEA Trust Commercial |
$1,343.63
|
| Rate for Payer: WPS Commercial |
$1,809.43
|
|
|
DRILL BIT 1.5 X 96MM MINI QUICK COUPLER DEPTH MARKER 310.507
|
Facility
|
IP
|
$2,349.00
|
|
| Hospital Charge Code |
2966175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,197.05 |
| Max. Negotiated Rate |
$2,247.52 |
| Rate for Payer: Aetna Commercial |
$2,198.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,294.77
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,247.52
|
| Rate for Payer: Health EOS Commercial |
$2,174.23
|
| Rate for Payer: HFN Commercial |
$2,247.52
|
| Rate for Payer: Multiplan Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,247.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.05
|
| Rate for Payer: Quartz Commercial |
$1,465.78
|
| Rate for Payer: WEA Trust Commercial |
$1,343.63
|
| Rate for Payer: WPS Commercial |
$1,809.43
|
|
|
DRILL BIT 1.6MM 52031630
|
Facility
|
IP
|
$2,582.00
|
|
| Hospital Charge Code |
6149647
|
|
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 1.6MM 52031630
|
Facility
|
OP
|
$2,582.00
|
|
| Hospital Charge Code |
6149647
|
|
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
|
|
|
DRILL BIT 16MM CANN FLEXIBLE 03.037.002
|
Facility
|
OP
|
$6,424.00
|
|
| Hospital Charge Code |
5178627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,870.67 |
| Max. Negotiated Rate |
$6,146.48 |
| Rate for Payer: Aetna Commercial |
$6,012.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,745.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,870.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,342.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,340.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,206.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,540.91
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna Commercial |
$6,146.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,738.77
|
| Rate for Payer: Health EOS Commercial |
$5,946.05
|
| Rate for Payer: HFN Commercial |
$6,146.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,010.72
|
| Rate for Payer: Multiplan Commercial |
$5,344.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,008.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,146.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,273.67
|
| Rate for Payer: Quartz Commercial |
$4,342.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4,008.58
|
| Rate for Payer: The Alliance Commercial |
$3,340.48
|
| Rate for Payer: WEA Trust Commercial |
$3,674.53
|
| Rate for Payer: WPS Commercial |
$4,948.41
|
|
|
DRILL BIT 16MM CANN FLEXIBLE 03.037.002
|
Facility
|
IP
|
$6,424.00
|
|
| Hospital Charge Code |
5178627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,273.67 |
| Max. Negotiated Rate |
$6,146.48 |
| Rate for Payer: Aetna Commercial |
$6,012.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,745.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,540.91
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna Commercial |
$6,146.48
|
| Rate for Payer: Health EOS Commercial |
$5,946.05
|
| Rate for Payer: HFN Commercial |
$6,146.48
|
| Rate for Payer: Multiplan Commercial |
$5,344.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,146.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,273.67
|
| Rate for Payer: Quartz Commercial |
$4,008.58
|
| Rate for Payer: WEA Trust Commercial |
$3,674.53
|
| Rate for Payer: WPS Commercial |
$4,948.41
|
|
|
DRILL BIT 1.7MM LONG AR-8916-14
|
Facility
|
IP
|
$1,263.00
|
|
| Hospital Charge Code |
5200629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.62 |
| Max. Negotiated Rate |
$1,208.44 |
| Rate for Payer: Aetna Commercial |
$1,182.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,129.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.17
|
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Cigna Commercial |
$1,208.44
|
| Rate for Payer: Health EOS Commercial |
$1,169.03
|
| Rate for Payer: HFN Commercial |
$1,208.44
|
| Rate for Payer: Multiplan Commercial |
$1,050.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,208.44
|
| Rate for Payer: Quartz Beloit One Network |
$643.62
|
| Rate for Payer: Quartz Commercial |
$788.11
|
| Rate for Payer: WEA Trust Commercial |
$722.44
|
| Rate for Payer: WPS Commercial |
$972.89
|
|
|
DRILL BIT 1.7MM LONG AR-8916-14
|
Facility
|
OP
|
$1,263.00
|
|
| Hospital Charge Code |
5200629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.79 |
| Max. Negotiated Rate |
$1,208.44 |
| Rate for Payer: Aetna Commercial |
$1,182.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,129.63
|
| Rate for Payer: Aetna Managed Medicare |
$367.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$853.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$656.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$630.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.17
|
| Rate for Payer: Cash Price |
$378.90
|
| Rate for Payer: Cigna Commercial |
$1,208.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.07
|
| Rate for Payer: Health EOS Commercial |
$1,169.03
|
| Rate for Payer: HFN Commercial |
$1,208.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$985.14
|
| Rate for Payer: Multiplan Commercial |
$1,050.82
|
| Rate for Payer: NAPHCARE Commercial |
$788.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,208.44
|
| Rate for Payer: Quartz Beloit One Network |
$643.62
|
| Rate for Payer: Quartz Commercial |
$853.79
|
| Rate for Payer: Quartz Medicare Advantage |
$788.11
|
| Rate for Payer: The Alliance Commercial |
$656.76
|
| Rate for Payer: WEA Trust Commercial |
$722.44
|
| Rate for Payer: WPS Commercial |
$972.89
|
|
|
DRILL BIT 1.7MM SHORT AR-8916-28
|
Facility
|
OP
|
$1,167.00
|
|
| Hospital Charge Code |
6166573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.83 |
| Max. Negotiated Rate |
$1,116.59 |
| Rate for Payer: Aetna Commercial |
$1,092.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,043.76
|
| Rate for Payer: Aetna Managed Medicare |
$339.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$788.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$582.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.25
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna Commercial |
$1,116.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.19
|
| Rate for Payer: Health EOS Commercial |
$1,080.18
|
| Rate for Payer: HFN Commercial |
$1,116.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$910.26
|
| Rate for Payer: Multiplan Commercial |
$970.94
|
| Rate for Payer: NAPHCARE Commercial |
$728.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,116.59
|
| Rate for Payer: Quartz Beloit One Network |
$594.70
|
| Rate for Payer: Quartz Commercial |
$788.89
|
| Rate for Payer: Quartz Medicare Advantage |
$728.21
|
| Rate for Payer: The Alliance Commercial |
$606.84
|
| Rate for Payer: WEA Trust Commercial |
$667.52
|
| Rate for Payer: WPS Commercial |
$898.94
|
|
|
DRILL BIT 1.7MM SHORT AR-8916-28
|
Facility
|
IP
|
$1,167.00
|
|
| Hospital Charge Code |
6166573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.70 |
| Max. Negotiated Rate |
$1,116.59 |
| Rate for Payer: Aetna Commercial |
$1,092.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,043.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.25
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna Commercial |
$1,116.59
|
| Rate for Payer: Health EOS Commercial |
$1,080.18
|
| Rate for Payer: HFN Commercial |
$1,116.59
|
| Rate for Payer: Multiplan Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,116.59
|
| Rate for Payer: Quartz Beloit One Network |
$594.70
|
| Rate for Payer: Quartz Commercial |
$728.21
|
| Rate for Payer: WEA Trust Commercial |
$667.52
|
| Rate for Payer: WPS Commercial |
$898.94
|
|
|
DRILL BIT 1.8MM QUICK COUPLER 310.510
|
Facility
|
OP
|
$2,615.00
|
|
| Hospital Charge Code |
2966178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.49 |
| Max. Negotiated Rate |
$2,502.03 |
| Rate for Payer: Aetna Commercial |
$2,447.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.86
|
| Rate for Payer: Aetna Managed Medicare |
$761.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,767.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,359.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.39
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,502.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,521.93
|
| Rate for Payer: Health EOS Commercial |
$2,420.44
|
| Rate for Payer: HFN Commercial |
$2,502.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,039.70
|
| Rate for Payer: Multiplan Commercial |
$2,175.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,631.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.60
|
| Rate for Payer: Quartz Commercial |
$1,767.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,631.76
|
| Rate for Payer: The Alliance Commercial |
$1,359.80
|
| Rate for Payer: WEA Trust Commercial |
$1,495.78
|
| Rate for Payer: WPS Commercial |
$2,014.33
|
|
|
DRILL BIT 1.8MM QUICK COUPLER 310.510
|
Facility
|
IP
|
$2,615.00
|
|
| Hospital Charge Code |
2966178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,332.60 |
| Max. Negotiated Rate |
$2,502.03 |
| Rate for Payer: Aetna Commercial |
$2,447.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.39
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,502.03
|
| Rate for Payer: Health EOS Commercial |
$2,420.44
|
| Rate for Payer: HFN Commercial |
$2,502.03
|
| Rate for Payer: Multiplan Commercial |
$2,175.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.60
|
| Rate for Payer: Quartz Commercial |
$1,631.76
|
| Rate for Payer: WEA Trust Commercial |
$1,495.78
|
| Rate for Payer: WPS Commercial |
$2,014.33
|
|
|
DRILL BIT 1.8 X 110MM WITH DEPTH MARK 310.509
|
Facility
|
OP
|
$2,273.00
|
|
| Hospital Charge Code |
2966177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.90 |
| 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: Aetna Managed Medicare |
$661.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,536.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,181.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,134.68
|
| 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: Dean Health DHI/DHP/ASO |
$1,322.89
|
| Rate for Payer: Health EOS Commercial |
$2,103.89
|
| Rate for Payer: HFN Commercial |
$2,174.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,772.94
|
| Rate for Payer: Multiplan Commercial |
$1,891.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,418.35
|
| 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 |
$1,536.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,418.35
|
| Rate for Payer: The Alliance Commercial |
$1,181.96
|
| Rate for Payer: WEA Trust Commercial |
$1,300.16
|
| Rate for Payer: WPS Commercial |
$1,750.89
|
|
|
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
|
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 2.0/2.4 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 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
|
|
