|
DRILL BIT 3.2 QUICK COUPLING 310.31
|
Facility
|
OP
|
$1,277.00
|
|
| Hospital Charge Code |
2966196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.86 |
| Max. Negotiated Rate |
$1,221.83 |
| Rate for Payer: Aetna Commercial |
$1,195.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.15
|
| Rate for Payer: Aetna Managed Medicare |
$371.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$863.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$664.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$637.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.88
|
| Rate for Payer: Cash Price |
$383.10
|
| Rate for Payer: Cigna Commercial |
$1,221.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.21
|
| Rate for Payer: Health EOS Commercial |
$1,181.99
|
| Rate for Payer: HFN Commercial |
$1,221.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.06
|
| Rate for Payer: Multiplan Commercial |
$1,062.46
|
| Rate for Payer: NAPHCARE Commercial |
$796.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.83
|
| Rate for Payer: Quartz Beloit One Network |
$650.76
|
| Rate for Payer: Quartz Commercial |
$863.25
|
| Rate for Payer: Quartz Medicare Advantage |
$796.85
|
| Rate for Payer: The Alliance Commercial |
$664.04
|
| Rate for Payer: WEA Trust Commercial |
$730.44
|
| Rate for Payer: WPS Commercial |
$983.67
|
|
|
DRILL BIT 3.2 QUICK COUPLING 310.31
|
Facility
|
IP
|
$1,277.00
|
|
| Hospital Charge Code |
2966196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.76 |
| Max. Negotiated Rate |
$1,221.83 |
| Rate for Payer: Aetna Commercial |
$1,195.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.88
|
| Rate for Payer: Cash Price |
$383.10
|
| Rate for Payer: Cigna Commercial |
$1,221.83
|
| Rate for Payer: Health EOS Commercial |
$1,181.99
|
| Rate for Payer: HFN Commercial |
$1,221.83
|
| Rate for Payer: Multiplan Commercial |
$1,062.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.83
|
| Rate for Payer: Quartz Beloit One Network |
$650.76
|
| Rate for Payer: Quartz Commercial |
$796.85
|
| Rate for Payer: WEA Trust Commercial |
$730.44
|
| Rate for Payer: WPS Commercial |
$983.67
|
|
|
DRILL BIT 3.2 RADIOLUCENT 4200-355-032
|
Facility
|
OP
|
$3,281.00
|
|
| Hospital Charge Code |
3287469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.43 |
| Max. Negotiated Rate |
$3,139.26 |
| Rate for Payer: Aetna Commercial |
$3,071.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,934.53
|
| Rate for Payer: Aetna Managed Medicare |
$955.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,217.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,706.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,637.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.49
|
| Rate for Payer: Cash Price |
$984.30
|
| Rate for Payer: Cigna Commercial |
$3,139.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,909.54
|
| Rate for Payer: Health EOS Commercial |
$3,036.89
|
| Rate for Payer: HFN Commercial |
$3,139.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,559.18
|
| Rate for Payer: Multiplan Commercial |
$2,729.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.00
|
| Rate for Payer: Quartz Commercial |
$2,217.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,047.34
|
| Rate for Payer: The Alliance Commercial |
$1,706.12
|
| Rate for Payer: WEA Trust Commercial |
$1,876.73
|
| Rate for Payer: WPS Commercial |
$2,527.35
|
|
|
DRILL BIT 3.2 RADIOLUCENT 4200-355-032
|
Facility
|
IP
|
$3,281.00
|
|
| Hospital Charge Code |
3287469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.00 |
| Max. Negotiated Rate |
$3,139.26 |
| Rate for Payer: Aetna Commercial |
$3,071.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,934.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.49
|
| Rate for Payer: Cash Price |
$984.30
|
| Rate for Payer: Cigna Commercial |
$3,139.26
|
| Rate for Payer: Health EOS Commercial |
$3,036.89
|
| Rate for Payer: HFN Commercial |
$3,139.26
|
| Rate for Payer: Multiplan Commercial |
$2,729.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.00
|
| Rate for Payer: Quartz Commercial |
$2,047.34
|
| Rate for Payer: WEA Trust Commercial |
$1,876.73
|
| Rate for Payer: WPS Commercial |
$2,527.35
|
|
|
DRILL BIT 3.2 X 130 JACOBS CHUCK 310.32
|
Facility
|
OP
|
$956.00
|
|
| Hospital Charge Code |
5349209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.39 |
| Max. Negotiated Rate |
$914.70 |
| Rate for Payer: Aetna Commercial |
$894.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$855.05
|
| Rate for Payer: Aetna Managed Medicare |
$278.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$646.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$497.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$477.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.95
|
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cigna Commercial |
$914.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$556.39
|
| Rate for Payer: Health EOS Commercial |
$884.87
|
| Rate for Payer: HFN Commercial |
$914.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$745.68
|
| Rate for Payer: Multiplan Commercial |
$795.39
|
| Rate for Payer: NAPHCARE Commercial |
$596.54
|
| Rate for Payer: Preferred Network Access Commercial |
$914.70
|
| Rate for Payer: Quartz Beloit One Network |
$487.18
|
| Rate for Payer: Quartz Commercial |
$646.26
|
| Rate for Payer: Quartz Medicare Advantage |
$596.54
|
| Rate for Payer: The Alliance Commercial |
$497.12
|
| Rate for Payer: WEA Trust Commercial |
$546.83
|
| Rate for Payer: WPS Commercial |
$736.41
|
|
|
DRILL BIT 3.2 X 130 JACOBS CHUCK 310.32
|
Facility
|
IP
|
$956.00
|
|
| Hospital Charge Code |
5349209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$487.18 |
| Max. Negotiated Rate |
$914.70 |
| Rate for Payer: Aetna Commercial |
$894.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$855.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.95
|
| Rate for Payer: Cash Price |
$286.80
|
| Rate for Payer: Cigna Commercial |
$914.70
|
| Rate for Payer: Health EOS Commercial |
$884.87
|
| Rate for Payer: HFN Commercial |
$914.70
|
| Rate for Payer: Multiplan Commercial |
$795.39
|
| Rate for Payer: Preferred Network Access Commercial |
$914.70
|
| Rate for Payer: Quartz Beloit One Network |
$487.18
|
| Rate for Payer: Quartz Commercial |
$596.54
|
| Rate for Payer: WEA Trust Commercial |
$546.83
|
| Rate for Payer: WPS Commercial |
$736.41
|
|
|
DRILL BIT 3.2 X 145MM 3-FLUTED NEEDLE POINT 03.010.103S
|
Facility
|
IP
|
$2,523.00
|
|
| Hospital Charge Code |
2966198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,285.72 |
| Max. Negotiated Rate |
$2,414.01 |
| Rate for Payer: Aetna Commercial |
$2,361.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,256.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.68
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna Commercial |
$2,414.01
|
| Rate for Payer: Health EOS Commercial |
$2,335.29
|
| Rate for Payer: HFN Commercial |
$2,414.01
|
| Rate for Payer: Multiplan Commercial |
$2,099.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.72
|
| Rate for Payer: Quartz Commercial |
$1,574.35
|
| Rate for Payer: WEA Trust Commercial |
$1,443.16
|
| Rate for Payer: WPS Commercial |
$1,943.47
|
|
|
DRILL BIT 3.2 X 145MM 3-FLUTED NEEDLE POINT 03.010.103S
|
Facility
|
OP
|
$2,523.00
|
|
| Hospital Charge Code |
2966198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.70 |
| Max. Negotiated Rate |
$2,414.01 |
| Rate for Payer: Aetna Commercial |
$2,361.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,256.57
|
| Rate for Payer: Aetna Managed Medicare |
$734.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,705.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,311.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.68
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cigna Commercial |
$2,414.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.39
|
| Rate for Payer: Health EOS Commercial |
$2,335.29
|
| Rate for Payer: HFN Commercial |
$2,414.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,967.94
|
| Rate for Payer: Multiplan Commercial |
$2,099.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.72
|
| Rate for Payer: Quartz Commercial |
$1,705.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.35
|
| Rate for Payer: The Alliance Commercial |
$1,311.96
|
| Rate for Payer: WEA Trust Commercial |
$1,443.16
|
| Rate for Payer: WPS Commercial |
$1,943.47
|
|
|
DRILL BIT 3.2 X145MM 700358
|
Facility
|
OP
|
$1,396.00
|
|
| Hospital Charge Code |
5459548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$406.52 |
| Max. Negotiated Rate |
$1,335.69 |
| Rate for Payer: Aetna Commercial |
$1,306.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,248.58
|
| Rate for Payer: Aetna Managed Medicare |
$406.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$943.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$725.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$696.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$769.48
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$1,335.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$812.47
|
| Rate for Payer: Health EOS Commercial |
$1,292.14
|
| Rate for Payer: HFN Commercial |
$1,335.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,088.88
|
| Rate for Payer: Multiplan Commercial |
$1,161.47
|
| Rate for Payer: NAPHCARE Commercial |
$871.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,335.69
|
| Rate for Payer: Quartz Beloit One Network |
$711.40
|
| Rate for Payer: Quartz Commercial |
$943.70
|
| Rate for Payer: Quartz Medicare Advantage |
$871.10
|
| Rate for Payer: The Alliance Commercial |
$725.92
|
| Rate for Payer: WEA Trust Commercial |
$798.51
|
| Rate for Payer: WPS Commercial |
$1,075.34
|
|
|
DRILL BIT 3.2 X145MM 700358
|
Facility
|
IP
|
$1,396.00
|
|
| Hospital Charge Code |
5459548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$711.40 |
| Max. Negotiated Rate |
$1,335.69 |
| Rate for Payer: Aetna Commercial |
$1,306.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,248.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$769.48
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Cigna Commercial |
$1,335.69
|
| Rate for Payer: Health EOS Commercial |
$1,292.14
|
| Rate for Payer: HFN Commercial |
$1,335.69
|
| Rate for Payer: Multiplan Commercial |
$1,161.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,335.69
|
| Rate for Payer: Quartz Beloit One Network |
$711.40
|
| Rate for Payer: Quartz Commercial |
$871.10
|
| Rate for Payer: WEA Trust Commercial |
$798.51
|
| Rate for Payer: WPS Commercial |
$1,075.34
|
|
|
DRILL BIT 3.2 X 216MM NON-LOCKING SHORT 705032
|
Facility
|
IP
|
$3,349.00
|
|
| Hospital Charge Code |
5106959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,706.65 |
| Max. Negotiated Rate |
$3,204.32 |
| Rate for Payer: Aetna Commercial |
$3,134.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,995.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,845.97
|
| Rate for Payer: Cash Price |
$1,004.70
|
| Rate for Payer: Cigna Commercial |
$3,204.32
|
| Rate for Payer: Health EOS Commercial |
$3,099.83
|
| Rate for Payer: HFN Commercial |
$3,204.32
|
| Rate for Payer: Multiplan Commercial |
$2,786.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,706.65
|
| Rate for Payer: Quartz Commercial |
$2,089.78
|
| Rate for Payer: WEA Trust Commercial |
$1,915.63
|
| Rate for Payer: WPS Commercial |
$2,579.73
|
|
|
DRILL BIT 3.2 X 216MM NON-LOCKING SHORT 705032
|
Facility
|
OP
|
$3,349.00
|
|
| Hospital Charge Code |
5106959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.23 |
| Max. Negotiated Rate |
$3,204.32 |
| Rate for Payer: Aetna Commercial |
$3,134.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,995.35
|
| Rate for Payer: Aetna Managed Medicare |
$975.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,263.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,741.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,671.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,845.97
|
| Rate for Payer: Cash Price |
$1,004.70
|
| Rate for Payer: Cigna Commercial |
$3,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.12
|
| Rate for Payer: Health EOS Commercial |
$3,099.83
|
| Rate for Payer: HFN Commercial |
$3,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,612.22
|
| Rate for Payer: Multiplan Commercial |
$2,786.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,089.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,706.65
|
| Rate for Payer: Quartz Commercial |
$2,263.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,089.78
|
| Rate for Payer: The Alliance Commercial |
$1,741.48
|
| Rate for Payer: WEA Trust Commercial |
$1,915.63
|
| Rate for Payer: WPS Commercial |
$2,579.73
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060
|
Facility
|
OP
|
$3,328.00
|
|
| Hospital Charge Code |
2966194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$969.11 |
| Max. Negotiated Rate |
$3,184.23 |
| Rate for Payer: Aetna Commercial |
$3,115.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,976.56
|
| Rate for Payer: Aetna Managed Medicare |
$969.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,249.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,730.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,661.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,834.39
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$3,184.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,936.90
|
| Rate for Payer: Health EOS Commercial |
$3,080.40
|
| Rate for Payer: HFN Commercial |
$3,184.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,595.84
|
| Rate for Payer: Multiplan Commercial |
$2,768.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,076.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,184.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.95
|
| Rate for Payer: Quartz Commercial |
$2,249.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,076.67
|
| Rate for Payer: The Alliance Commercial |
$1,730.56
|
| Rate for Payer: WEA Trust Commercial |
$1,903.62
|
| Rate for Payer: WPS Commercial |
$2,563.56
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060
|
Facility
|
IP
|
$3,328.00
|
|
| Hospital Charge Code |
2966194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,695.95 |
| Max. Negotiated Rate |
$3,184.23 |
| Rate for Payer: Aetna Commercial |
$3,115.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,976.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,834.39
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$3,184.23
|
| Rate for Payer: Health EOS Commercial |
$3,080.40
|
| Rate for Payer: HFN Commercial |
$3,184.23
|
| Rate for Payer: Multiplan Commercial |
$2,768.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,184.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.95
|
| Rate for Payer: Quartz Commercial |
$2,076.67
|
| Rate for Payer: WEA Trust Commercial |
$1,903.62
|
| Rate for Payer: WPS Commercial |
$2,563.56
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060S
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2966193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,209.46 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$3,929.95
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
DRILL BIT 3.2 X 330MM 3-FLUTED 100MM CALIBRATED 03.010.060S
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2966193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,833.98 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,257.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,274.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,143.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,665.44
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,912.44
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$4,257.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,929.95
|
| Rate for Payer: The Alliance Commercial |
$3,274.96
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
DRILL BIT 3.4MM SPADE PILOT 214-00-006
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3713498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$921.94 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Aetna Managed Medicare |
$921.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,140.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,646.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,842.61
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,469.48
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,975.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$2,140.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,975.58
|
| Rate for Payer: The Alliance Commercial |
$1,646.32
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
DRILL BIT 3.4MM SPADE PILOT 214-00-006
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3713498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,613.39 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$1,975.58
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
DRILL BIT 3.5MM ARTHREX AR-4160-35
|
Facility
|
IP
|
$1,263.00
|
|
| Hospital Charge Code |
5416037
|
|
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 3.5MM ARTHREX AR-4160-35
|
Facility
|
OP
|
$1,263.00
|
|
| Hospital Charge Code |
5416037
|
|
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 3.5MM CALIBRATED AR-8956C-35PD
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5599720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.50 |
| 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: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| 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: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| 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 |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
DRILL BIT 3.5MM CALIBRATED AR-8956C-35PD
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5599720
|
|
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 3.5MM CANN TWIST 702450
|
Facility
|
IP
|
$2,256.00
|
|
| Hospital Charge Code |
5582937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,149.66 |
| Max. Negotiated Rate |
$2,158.54 |
| Rate for Payer: Aetna Commercial |
$2,111.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.51
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,158.54
|
| Rate for Payer: Health EOS Commercial |
$2,088.15
|
| Rate for Payer: HFN Commercial |
$2,158.54
|
| Rate for Payer: Multiplan Commercial |
$1,876.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.66
|
| Rate for Payer: Quartz Commercial |
$1,407.74
|
| Rate for Payer: WEA Trust Commercial |
$1,290.43
|
| Rate for Payer: WPS Commercial |
$1,737.80
|
|
|
DRILL BIT 3.5MM CANN TWIST 702450
|
Facility
|
OP
|
$2,256.00
|
|
| Hospital Charge Code |
5582937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.95 |
| Max. Negotiated Rate |
$2,158.54 |
| Rate for Payer: Aetna Commercial |
$2,111.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.77
|
| Rate for Payer: Aetna Managed Medicare |
$656.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.51
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,158.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.99
|
| Rate for Payer: Health EOS Commercial |
$2,088.15
|
| Rate for Payer: HFN Commercial |
$2,158.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.68
|
| Rate for Payer: Multiplan Commercial |
$1,876.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.66
|
| Rate for Payer: Quartz Commercial |
$1,525.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.74
|
| Rate for Payer: The Alliance Commercial |
$1,173.12
|
| Rate for Payer: WEA Trust Commercial |
$1,290.43
|
| Rate for Payer: WPS Commercial |
$1,737.80
|
|
|
DRILL BIT 3.5MM X12.7CM 00-2318-035-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
5349273
|
|
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
|
|
