|
DRILL BIT 2MM CANN AR-8933-20C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5415811
|
|
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
|
|
|
DRILL BIT 3.0 MGS STERILE AR-9628S
|
Facility
|
OP
|
$3,139.00
|
|
| Hospital Charge Code |
5603575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
DRILL BIT 3.0 MGS STERILE AR-9628S
|
Facility
|
IP
|
$3,139.00
|
|
| Hospital Charge Code |
5603575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.63 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$1,958.74
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
DRILL BIT 3.0MM AR-8943-36
|
Facility
|
IP
|
$1,531.00
|
|
| Hospital Charge Code |
5349251
|
|
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 3.0MM AR-8943-36
|
Facility
|
OP
|
$1,531.00
|
|
| Hospital Charge Code |
5349251
|
|
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 3.0MM CALIBRATED LONG AR-8970-30L
|
Facility
|
IP
|
$2,596.00
|
|
| Hospital Charge Code |
5603783
|
|
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 3.0MM CALIBRATED LONG AR-8970-30L
|
Facility
|
OP
|
$2,596.00
|
|
| Hospital Charge Code |
5603783
|
|
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 3.1 X 216MM LOCK SHORT 705031
|
Facility
|
OP
|
$1,857.00
|
|
| Hospital Charge Code |
5458970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.76 |
| Max. Negotiated Rate |
$1,776.78 |
| Rate for Payer: Aetna Commercial |
$1,738.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,660.90
|
| Rate for Payer: Aetna Managed Medicare |
$540.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,255.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$965.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$927.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.58
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna Commercial |
$1,776.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,080.77
|
| Rate for Payer: Health EOS Commercial |
$1,718.84
|
| Rate for Payer: HFN Commercial |
$1,776.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,448.46
|
| Rate for Payer: Multiplan Commercial |
$1,545.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,158.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,776.78
|
| Rate for Payer: Quartz Beloit One Network |
$946.33
|
| Rate for Payer: Quartz Commercial |
$1,255.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,158.77
|
| Rate for Payer: The Alliance Commercial |
$965.64
|
| Rate for Payer: WEA Trust Commercial |
$1,062.20
|
| Rate for Payer: WPS Commercial |
$1,430.45
|
|
|
DRILL BIT 3.1 X 216MM LOCK SHORT 705031
|
Facility
|
IP
|
$1,857.00
|
|
| Hospital Charge Code |
5458970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$946.33 |
| Max. Negotiated Rate |
$1,776.78 |
| Rate for Payer: Aetna Commercial |
$1,738.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,660.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.58
|
| Rate for Payer: Cash Price |
$557.10
|
| Rate for Payer: Cigna Commercial |
$1,776.78
|
| Rate for Payer: Health EOS Commercial |
$1,718.84
|
| Rate for Payer: HFN Commercial |
$1,776.78
|
| Rate for Payer: Multiplan Commercial |
$1,545.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,776.78
|
| Rate for Payer: Quartz Beloit One Network |
$946.33
|
| Rate for Payer: Quartz Commercial |
$1,158.77
|
| Rate for Payer: WEA Trust Commercial |
$1,062.20
|
| Rate for Payer: WPS Commercial |
$1,430.45
|
|
|
DRILL BIT 3.1 X 238MM LOCK MEDIUM 705077
|
Facility
|
IP
|
$4,299.00
|
|
| Hospital Charge Code |
5458923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,190.77 |
| Max. Negotiated Rate |
$4,113.28 |
| Rate for Payer: Aetna Commercial |
$4,023.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,845.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.61
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cigna Commercial |
$4,113.28
|
| Rate for Payer: Health EOS Commercial |
$3,979.15
|
| Rate for Payer: HFN Commercial |
$4,113.28
|
| Rate for Payer: Multiplan Commercial |
$3,576.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,113.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.77
|
| Rate for Payer: Quartz Commercial |
$2,682.58
|
| Rate for Payer: WEA Trust Commercial |
$2,459.03
|
| Rate for Payer: WPS Commercial |
$3,311.52
|
|
|
DRILL BIT 3.1 X 238MM LOCK MEDIUM 705077
|
Facility
|
OP
|
$4,299.00
|
|
| Hospital Charge Code |
5458923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.87 |
| Max. Negotiated Rate |
$4,113.28 |
| Rate for Payer: Aetna Commercial |
$4,023.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,845.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,906.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,235.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,146.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.61
|
| Rate for Payer: Cash Price |
$1,289.70
|
| Rate for Payer: Cigna Commercial |
$4,113.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,502.02
|
| Rate for Payer: Health EOS Commercial |
$3,979.15
|
| Rate for Payer: HFN Commercial |
$4,113.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,353.22
|
| Rate for Payer: Multiplan Commercial |
$3,576.77
|
| Rate for Payer: NAPHCARE Commercial |
$2,682.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,113.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.77
|
| Rate for Payer: Quartz Commercial |
$2,906.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,682.58
|
| Rate for Payer: The Alliance Commercial |
$2,235.48
|
| Rate for Payer: WEA Trust Commercial |
$2,459.03
|
| Rate for Payer: WPS Commercial |
$3,311.52
|
|
|
DRILL BIT 3.2 MM 3-FLUTED 315.29
|
Facility
|
IP
|
$2,196.00
|
|
| Hospital Charge Code |
2966195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.08 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,370.30
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
DRILL BIT 3.2 MM 3-FLUTED 315.29
|
Facility
|
OP
|
$2,196.00
|
|
| Hospital Charge Code |
2966195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.48 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Aetna Managed Medicare |
$639.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,484.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,096.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.07
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.88
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,484.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,370.30
|
| Rate for Payer: The Alliance Commercial |
$1,141.92
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
DRILL BIT 3.2MM X12.7CM 1/8 00-2318-032-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
5264631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.39 |
| Max. Negotiated Rate |
$836.24 |
| Rate for Payer: Aetna Commercial |
$818.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.75
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$836.24
|
| Rate for Payer: Health EOS Commercial |
$808.97
|
| Rate for Payer: HFN Commercial |
$836.24
|
| Rate for Payer: Multiplan Commercial |
$727.17
|
| Rate for Payer: Preferred Network Access Commercial |
$836.24
|
| Rate for Payer: Quartz Beloit One Network |
$445.39
|
| Rate for Payer: Quartz Commercial |
$545.38
|
| Rate for Payer: WEA Trust Commercial |
$499.93
|
| Rate for Payer: WPS Commercial |
$673.24
|
|
|
DRILL BIT 3.2MM X12.7CM 1/8 00-2318-032-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
5264631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.51 |
| Max. Negotiated Rate |
$836.24 |
| Rate for Payer: Aetna Commercial |
$818.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.71
|
| Rate for Payer: Aetna Managed Medicare |
$254.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$590.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$454.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.75
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$836.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.67
|
| Rate for Payer: Health EOS Commercial |
$808.97
|
| Rate for Payer: HFN Commercial |
$836.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$681.72
|
| Rate for Payer: Multiplan Commercial |
$727.17
|
| Rate for Payer: NAPHCARE Commercial |
$545.38
|
| Rate for Payer: Preferred Network Access Commercial |
$836.24
|
| Rate for Payer: Quartz Beloit One Network |
$445.39
|
| Rate for Payer: Quartz Commercial |
$590.82
|
| Rate for Payer: Quartz Medicare Advantage |
$545.38
|
| Rate for Payer: The Alliance Commercial |
$454.48
|
| Rate for Payer: WEA Trust Commercial |
$499.93
|
| Rate for Payer: WPS Commercial |
$673.24
|
|
|
DRILL BIT 3.2MM X 20MM RINGLOC+ QUICK CONNECT 31-323220
|
Facility
|
IP
|
$1,376.00
|
|
| Hospital Charge Code |
6065701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.21 |
| Max. Negotiated Rate |
$1,316.56 |
| Rate for Payer: Aetna Commercial |
$1,287.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.45
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,316.56
|
| Rate for Payer: Health EOS Commercial |
$1,273.63
|
| Rate for Payer: HFN Commercial |
$1,316.56
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.56
|
| Rate for Payer: Quartz Beloit One Network |
$701.21
|
| Rate for Payer: Quartz Commercial |
$858.62
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
DRILL BIT 3.2MM X 20MM RINGLOC+ QUICK CONNECT 31-323220
|
Facility
|
OP
|
$1,376.00
|
|
| Hospital Charge Code |
6065701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.69 |
| Max. Negotiated Rate |
$1,316.56 |
| Rate for Payer: Aetna Commercial |
$1,287.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Aetna Managed Medicare |
$400.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$930.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.45
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,316.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.83
|
| Rate for Payer: Health EOS Commercial |
$1,273.63
|
| Rate for Payer: HFN Commercial |
$1,316.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.28
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: NAPHCARE Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.56
|
| Rate for Payer: Quartz Beloit One Network |
$701.21
|
| Rate for Payer: Quartz Commercial |
$930.18
|
| Rate for Payer: Quartz Medicare Advantage |
$858.62
|
| Rate for Payer: The Alliance Commercial |
$715.52
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
DRILL BIT 3.2MM X 230MM 705232
|
Facility
|
IP
|
$2,137.00
|
|
| Hospital Charge Code |
6177949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,089.02 |
| Max. Negotiated Rate |
$2,044.68 |
| Rate for Payer: Aetna Commercial |
$2,000.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.91
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,044.68
|
| Rate for Payer: Health EOS Commercial |
$1,978.01
|
| Rate for Payer: HFN Commercial |
$2,044.68
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,044.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.02
|
| Rate for Payer: Quartz Commercial |
$1,333.49
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: WPS Commercial |
$1,646.13
|
|
|
DRILL BIT 3.2MM X 230MM 705232
|
Facility
|
OP
|
$2,137.00
|
|
| Hospital Charge Code |
6177949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.29 |
| Max. Negotiated Rate |
$2,044.68 |
| Rate for Payer: Aetna Commercial |
$2,000.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Aetna Managed Medicare |
$622.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,444.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,111.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,066.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.91
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,044.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,243.73
|
| Rate for Payer: Health EOS Commercial |
$1,978.01
|
| Rate for Payer: HFN Commercial |
$2,044.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,666.86
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,333.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,044.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.02
|
| Rate for Payer: Quartz Commercial |
$1,444.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,333.49
|
| Rate for Payer: The Alliance Commercial |
$1,111.24
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: WPS Commercial |
$1,646.13
|
|
|
DRILL BIT 3.2MM X 30MM RINGLOC+ QUICK CONNECT 31-323230
|
Facility
|
IP
|
$1,431.00
|
|
| Hospital Charge Code |
5729664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.24 |
| Max. Negotiated Rate |
$1,369.18 |
| Rate for Payer: Aetna Commercial |
$1,339.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.77
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,369.18
|
| Rate for Payer: Health EOS Commercial |
$1,324.53
|
| Rate for Payer: HFN Commercial |
$1,369.18
|
| Rate for Payer: Multiplan Commercial |
$1,190.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,369.18
|
| Rate for Payer: Quartz Beloit One Network |
$729.24
|
| Rate for Payer: Quartz Commercial |
$892.94
|
| Rate for Payer: WEA Trust Commercial |
$818.53
|
| Rate for Payer: WPS Commercial |
$1,102.30
|
|
|
DRILL BIT 3.2MM X 30MM RINGLOC+ QUICK CONNECT 31-323230
|
Facility
|
OP
|
$1,431.00
|
|
| Hospital Charge Code |
5729664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.71 |
| Max. Negotiated Rate |
$1,369.18 |
| Rate for Payer: Aetna Commercial |
$1,339.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.89
|
| Rate for Payer: Aetna Managed Medicare |
$416.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$967.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$744.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$714.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.77
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,369.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.84
|
| Rate for Payer: Health EOS Commercial |
$1,324.53
|
| Rate for Payer: HFN Commercial |
$1,369.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.18
|
| Rate for Payer: Multiplan Commercial |
$1,190.59
|
| Rate for Payer: NAPHCARE Commercial |
$892.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,369.18
|
| Rate for Payer: Quartz Beloit One Network |
$729.24
|
| Rate for Payer: Quartz Commercial |
$967.36
|
| Rate for Payer: Quartz Medicare Advantage |
$892.94
|
| Rate for Payer: The Alliance Commercial |
$744.12
|
| Rate for Payer: WEA Trust Commercial |
$818.53
|
| Rate for Payer: WPS Commercial |
$1,102.30
|
|
|
DRILL BIT 3.2MM X 40MM RINGLOC+ QUICK CONNECT 31-323240
|
Facility
|
IP
|
$1,323.00
|
|
| Hospital Charge Code |
6178522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$674.20 |
| Max. Negotiated Rate |
$1,265.85 |
| Rate for Payer: Aetna Commercial |
$1,238.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.24
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna Commercial |
$1,265.85
|
| Rate for Payer: Health EOS Commercial |
$1,224.57
|
| Rate for Payer: HFN Commercial |
$1,265.85
|
| Rate for Payer: Multiplan Commercial |
$1,100.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.85
|
| Rate for Payer: Quartz Beloit One Network |
$674.20
|
| Rate for Payer: Quartz Commercial |
$825.55
|
| Rate for Payer: WEA Trust Commercial |
$756.76
|
| Rate for Payer: WPS Commercial |
$1,019.11
|
|
|
DRILL BIT 3.2MM X 40MM RINGLOC+ QUICK CONNECT 31-323240
|
Facility
|
OP
|
$1,323.00
|
|
| Hospital Charge Code |
6178522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.26 |
| Max. Negotiated Rate |
$1,265.85 |
| Rate for Payer: Aetna Commercial |
$1,238.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.29
|
| Rate for Payer: Aetna Managed Medicare |
$385.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$894.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.24
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna Commercial |
$1,265.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.99
|
| Rate for Payer: Health EOS Commercial |
$1,224.57
|
| Rate for Payer: HFN Commercial |
$1,265.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.94
|
| Rate for Payer: Multiplan Commercial |
$1,100.74
|
| Rate for Payer: NAPHCARE Commercial |
$825.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.85
|
| Rate for Payer: Quartz Beloit One Network |
$674.20
|
| Rate for Payer: Quartz Commercial |
$894.35
|
| Rate for Payer: Quartz Medicare Advantage |
$825.55
|
| Rate for Payer: The Alliance Commercial |
$687.96
|
| Rate for Payer: WEA Trust Commercial |
$756.76
|
| Rate for Payer: WPS Commercial |
$1,019.11
|
|
|
DRILL BIT 3.2 PERCUTANEOUS 324.212
|
Facility
|
OP
|
$2,898.00
|
|
| Hospital Charge Code |
2966197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$843.90 |
| Max. Negotiated Rate |
$2,772.81 |
| Rate for Payer: Aetna Commercial |
$2,712.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,591.97
|
| Rate for Payer: Aetna Managed Medicare |
$843.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,959.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,506.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,446.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,597.38
|
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Cigna Commercial |
$2,772.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,686.64
|
| Rate for Payer: Health EOS Commercial |
$2,682.39
|
| Rate for Payer: HFN Commercial |
$2,772.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,260.44
|
| Rate for Payer: Multiplan Commercial |
$2,411.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,808.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,772.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,476.82
|
| Rate for Payer: Quartz Commercial |
$1,959.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,808.35
|
| Rate for Payer: The Alliance Commercial |
$1,506.96
|
| Rate for Payer: WEA Trust Commercial |
$1,657.66
|
| Rate for Payer: WPS Commercial |
$2,232.33
|
|
|
DRILL BIT 3.2 PERCUTANEOUS 324.212
|
Facility
|
IP
|
$2,898.00
|
|
| Hospital Charge Code |
2966197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,476.82 |
| Max. Negotiated Rate |
$2,772.81 |
| Rate for Payer: Aetna Commercial |
$2,712.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,591.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,597.38
|
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Cigna Commercial |
$2,772.81
|
| Rate for Payer: Health EOS Commercial |
$2,682.39
|
| Rate for Payer: HFN Commercial |
$2,772.81
|
| Rate for Payer: Multiplan Commercial |
$2,411.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,772.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,476.82
|
| Rate for Payer: Quartz Commercial |
$1,808.35
|
| Rate for Payer: WEA Trust Commercial |
$1,657.66
|
| Rate for Payer: WPS Commercial |
$2,232.33
|
|
