|
DRILL BIT 2.0 QUICK COUPLING 310.21
|
Facility
|
IP
|
$1,482.00
|
|
| Hospital Charge Code |
2966181
|
|
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 2.0 QUICK COUPLING 310.21
|
Facility
|
OP
|
$1,482.00
|
|
| Hospital Charge Code |
2966181
|
|
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 2.0 X 105MM
|
Facility
|
OP
|
$2,135.00
|
|
| Hospital Charge Code |
2964736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.71 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Aetna Managed Medicare |
$621.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.57
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.30
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,443.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.24
|
| Rate for Payer: The Alliance Commercial |
$1,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
DRILL BIT 2.0 X 105MM
|
Facility
|
IP
|
$2,135.00
|
|
| Hospital Charge Code |
2964736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.00 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
DRILL BIT 2.0 X 140MM WITH DEPTH MARK 323.062
|
Facility
|
IP
|
$2,273.00
|
|
| Hospital Charge Code |
2966182
|
|
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 2.0 X 140MM WITH DEPTH MARK 323.062
|
Facility
|
OP
|
$2,273.00
|
|
| Hospital Charge Code |
2966182
|
|
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 2.0 X 140 QUICK COUPLE 03.133.101
|
Facility
|
OP
|
$2,151.00
|
|
| Hospital Charge Code |
6180414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.37 |
| Max. Negotiated Rate |
$2,058.08 |
| Rate for Payer: Aetna Commercial |
$2,013.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,923.85
|
| Rate for Payer: Aetna Managed Medicare |
$626.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,454.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,118.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,073.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,185.63
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cigna Commercial |
$2,058.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,251.88
|
| Rate for Payer: Health EOS Commercial |
$1,990.97
|
| Rate for Payer: HFN Commercial |
$2,058.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,677.78
|
| Rate for Payer: Multiplan Commercial |
$1,789.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,342.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,058.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.15
|
| Rate for Payer: Quartz Commercial |
$1,454.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,342.22
|
| Rate for Payer: The Alliance Commercial |
$1,118.52
|
| Rate for Payer: WEA Trust Commercial |
$1,230.37
|
| Rate for Payer: WPS Commercial |
$1,656.92
|
|
|
DRILL BIT 2.0 X 140 QUICK COUPLE 03.133.101
|
Facility
|
IP
|
$2,151.00
|
|
| Hospital Charge Code |
6180414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,096.15 |
| Max. Negotiated Rate |
$2,058.08 |
| Rate for Payer: Aetna Commercial |
$2,013.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,923.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,185.63
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cigna Commercial |
$2,058.08
|
| Rate for Payer: Health EOS Commercial |
$1,990.97
|
| Rate for Payer: HFN Commercial |
$2,058.08
|
| Rate for Payer: Multiplan Commercial |
$1,789.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,058.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.15
|
| Rate for Payer: Quartz Commercial |
$1,342.22
|
| Rate for Payer: WEA Trust Commercial |
$1,230.37
|
| Rate for Payer: WPS Commercial |
$1,656.92
|
|
|
DRILL BIT 2.0 X 150 CANN 310.221
|
Facility
|
OP
|
$4,976.00
|
|
| Hospital Charge Code |
2966179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,449.01 |
| Max. Negotiated Rate |
$4,761.04 |
| Rate for Payer: Aetna Commercial |
$4,657.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,450.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,449.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,363.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,587.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,484.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,742.77
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$4,761.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,896.03
|
| Rate for Payer: Health EOS Commercial |
$4,605.79
|
| Rate for Payer: HFN Commercial |
$4,761.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,881.28
|
| Rate for Payer: Multiplan Commercial |
$4,140.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,105.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,761.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,535.77
|
| Rate for Payer: Quartz Commercial |
$3,363.78
|
| Rate for Payer: Quartz Medicare Advantage |
$3,105.02
|
| Rate for Payer: The Alliance Commercial |
$2,587.52
|
| Rate for Payer: WEA Trust Commercial |
$2,846.27
|
| Rate for Payer: WPS Commercial |
$3,833.01
|
|
|
DRILL BIT 2.0 X 150 CANN 310.221
|
Facility
|
IP
|
$4,976.00
|
|
| Hospital Charge Code |
2966179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.77 |
| Max. Negotiated Rate |
$4,761.04 |
| Rate for Payer: Aetna Commercial |
$4,657.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,450.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,742.77
|
| Rate for Payer: Cash Price |
$1,492.80
|
| Rate for Payer: Cigna Commercial |
$4,761.04
|
| Rate for Payer: Health EOS Commercial |
$4,605.79
|
| Rate for Payer: HFN Commercial |
$4,761.04
|
| Rate for Payer: Multiplan Commercial |
$4,140.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,761.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,535.77
|
| Rate for Payer: Quartz Commercial |
$3,105.02
|
| Rate for Payer: WEA Trust Commercial |
$2,846.27
|
| Rate for Payer: WPS Commercial |
$3,833.01
|
|
|
DRILL BIT 2.0 X 150MM ASNIS III 702453
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
6182540
|
|
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 2.0 X 150MM ASNIS III 702453
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
6182540
|
|
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 2.0 X 30MM ORTHOLOC 58880020
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5415912
|
|
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 2.0 X 30MM ORTHOLOC 58880020
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5415912
|
|
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 2.0 X 60MM ORTHOLOC 58850020
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5729842
|
|
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 2.0 X 60MM ORTHOLOC 58850020
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5729842
|
|
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 2.0 X 65MM MINI QUICK COUPLER 310.201
|
Facility
|
OP
|
$1,370.00
|
|
| Hospital Charge Code |
2966183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.94 |
| Max. Negotiated Rate |
$1,310.82 |
| Rate for Payer: Aetna Commercial |
$1,282.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.33
|
| Rate for Payer: Aetna Managed Medicare |
$398.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.14
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,310.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.34
|
| Rate for Payer: Health EOS Commercial |
$1,268.07
|
| Rate for Payer: HFN Commercial |
$1,310.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,139.84
|
| Rate for Payer: NAPHCARE Commercial |
$854.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.82
|
| Rate for Payer: Quartz Beloit One Network |
$698.15
|
| Rate for Payer: Quartz Commercial |
$926.12
|
| Rate for Payer: Quartz Medicare Advantage |
$854.88
|
| Rate for Payer: The Alliance Commercial |
$712.40
|
| Rate for Payer: WEA Trust Commercial |
$783.64
|
| Rate for Payer: WPS Commercial |
$1,055.31
|
|
|
DRILL BIT 2.0 X 65MM MINI QUICK COUPLER 310.201
|
Facility
|
IP
|
$1,370.00
|
|
| Hospital Charge Code |
2966183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$698.15 |
| Max. Negotiated Rate |
$1,310.82 |
| Rate for Payer: Aetna Commercial |
$1,282.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.14
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,310.82
|
| Rate for Payer: Health EOS Commercial |
$1,268.07
|
| Rate for Payer: HFN Commercial |
$1,310.82
|
| Rate for Payer: Multiplan Commercial |
$1,139.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.82
|
| Rate for Payer: Quartz Beloit One Network |
$698.15
|
| Rate for Payer: Quartz Commercial |
$854.88
|
| Rate for Payer: WEA Trust Commercial |
$783.64
|
| Rate for Payer: WPS Commercial |
$1,055.31
|
|
|
DRILL BIT 2.0 X 85MM JACOBS CHUCK 310.20
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
5563412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.27 |
| Max. Negotiated Rate |
$894.61 |
| Rate for Payer: Aetna Commercial |
$875.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$836.26
|
| Rate for Payer: Aetna Managed Medicare |
$272.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$632.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.37
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$894.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$544.17
|
| Rate for Payer: Health EOS Commercial |
$865.44
|
| Rate for Payer: HFN Commercial |
$894.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.30
|
| Rate for Payer: Multiplan Commercial |
$777.92
|
| Rate for Payer: NAPHCARE Commercial |
$583.44
|
| Rate for Payer: Preferred Network Access Commercial |
$894.61
|
| Rate for Payer: Quartz Beloit One Network |
$476.48
|
| Rate for Payer: Quartz Commercial |
$632.06
|
| Rate for Payer: Quartz Medicare Advantage |
$583.44
|
| Rate for Payer: The Alliance Commercial |
$486.20
|
| Rate for Payer: WEA Trust Commercial |
$534.82
|
| Rate for Payer: WPS Commercial |
$720.23
|
|
|
DRILL BIT 2.0 X 85MM JACOBS CHUCK 310.20
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
5563412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.48 |
| Max. Negotiated Rate |
$894.61 |
| Rate for Payer: Aetna Commercial |
$875.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$836.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.37
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$894.61
|
| Rate for Payer: Health EOS Commercial |
$865.44
|
| Rate for Payer: HFN Commercial |
$894.61
|
| Rate for Payer: Multiplan Commercial |
$777.92
|
| Rate for Payer: Preferred Network Access Commercial |
$894.61
|
| Rate for Payer: Quartz Beloit One Network |
$476.48
|
| Rate for Payer: Quartz Commercial |
$583.44
|
| Rate for Payer: WEA Trust Commercial |
$534.82
|
| Rate for Payer: WPS Commercial |
$720.23
|
|
|
DRILL BIT 2.2MM CANNULATED DSDS0022
|
Facility
|
OP
|
$2,602.00
|
|
| Hospital Charge Code |
6165647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.70 |
| Max. Negotiated Rate |
$2,489.59 |
| Rate for Payer: Aetna Commercial |
$2,435.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,327.23
|
| Rate for Payer: Aetna Managed Medicare |
$757.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,758.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,353.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,298.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.22
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$2,489.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,514.36
|
| Rate for Payer: Health EOS Commercial |
$2,408.41
|
| Rate for Payer: HFN Commercial |
$2,489.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,029.56
|
| Rate for Payer: Multiplan Commercial |
$2,164.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,489.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.98
|
| Rate for Payer: Quartz Commercial |
$1,758.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,623.65
|
| Rate for Payer: The Alliance Commercial |
$1,353.04
|
| Rate for Payer: WEA Trust Commercial |
$1,488.34
|
| Rate for Payer: WPS Commercial |
$2,004.32
|
|
|
DRILL BIT 2.2MM CANNULATED DSDS0022
|
Facility
|
IP
|
$2,602.00
|
|
| Hospital Charge Code |
6165647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.98 |
| Max. Negotiated Rate |
$2,489.59 |
| Rate for Payer: Aetna Commercial |
$2,435.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,327.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.22
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$2,489.59
|
| Rate for Payer: Health EOS Commercial |
$2,408.41
|
| Rate for Payer: HFN Commercial |
$2,489.59
|
| Rate for Payer: Multiplan Commercial |
$2,164.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,489.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.98
|
| Rate for Payer: Quartz Commercial |
$1,623.65
|
| Rate for Payer: WEA Trust Commercial |
$1,488.34
|
| Rate for Payer: WPS Commercial |
$2,004.32
|
|
|
DRILL BIT 2.3MM ACUMED QUICK COUPLING 80-0627
|
Facility
|
OP
|
$2,266.00
|
|
| Hospital Charge Code |
5547305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.86 |
| Max. Negotiated Rate |
$2,168.11 |
| Rate for Payer: Aetna Commercial |
$2,120.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.71
|
| Rate for Payer: Aetna Managed Medicare |
$659.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,531.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,178.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,131.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,249.02
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$2,168.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,318.81
|
| Rate for Payer: Health EOS Commercial |
$2,097.41
|
| Rate for Payer: HFN Commercial |
$2,168.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,767.48
|
| Rate for Payer: Multiplan Commercial |
$1,885.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,168.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.75
|
| Rate for Payer: Quartz Commercial |
$1,531.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,413.98
|
| Rate for Payer: The Alliance Commercial |
$1,178.32
|
| Rate for Payer: WEA Trust Commercial |
$1,296.15
|
| Rate for Payer: WPS Commercial |
$1,745.50
|
|
|
DRILL BIT 2.3MM ACUMED QUICK COUPLING 80-0627
|
Facility
|
IP
|
$2,266.00
|
|
| Hospital Charge Code |
5547305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.75 |
| Max. Negotiated Rate |
$2,168.11 |
| Rate for Payer: Aetna Commercial |
$2,120.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,249.02
|
| Rate for Payer: Cash Price |
$679.80
|
| Rate for Payer: Cigna Commercial |
$2,168.11
|
| Rate for Payer: Health EOS Commercial |
$2,097.41
|
| Rate for Payer: HFN Commercial |
$2,168.11
|
| Rate for Payer: Multiplan Commercial |
$1,885.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,168.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.75
|
| Rate for Payer: Quartz Commercial |
$1,413.98
|
| Rate for Payer: WEA Trust Commercial |
$1,296.15
|
| Rate for Payer: WPS Commercial |
$1,745.50
|
|
|
DRILL BIT 2.4MM CLX CLX-072-24
|
Facility
|
OP
|
$3,458.00
|
|
| Hospital Charge Code |
5787648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.97 |
| Max. Negotiated Rate |
$3,308.61 |
| Rate for Payer: Aetna Commercial |
$3,236.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,092.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,006.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,337.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,798.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,726.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,906.05
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,308.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,012.56
|
| Rate for Payer: Health EOS Commercial |
$3,200.72
|
| Rate for Payer: HFN Commercial |
$3,308.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,697.24
|
| Rate for Payer: Multiplan Commercial |
$2,877.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,157.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,308.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,762.20
|
| Rate for Payer: Quartz Commercial |
$2,337.61
|
| Rate for Payer: Quartz Medicare Advantage |
$2,157.79
|
| Rate for Payer: The Alliance Commercial |
$1,798.16
|
| Rate for Payer: WEA Trust Commercial |
$1,977.98
|
| Rate for Payer: WPS Commercial |
$2,663.70
|
|
