|
DRILL BIT 4.0MM AR-4160-40
|
Facility
|
OP
|
$1,600.00
|
|
| Hospital Charge Code |
5591336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$465.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.20
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$998.40
|
| Rate for Payer: The Alliance Commercial |
$832.00
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
DRILL BIT 4.0MM AR-4160-40
|
Facility
|
IP
|
$1,600.00
|
|
| Hospital Charge Code |
5591336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
DRILL BIT 4.0MM X 200MM 5085-2-040
|
Facility
|
IP
|
$1,909.00
|
|
| Hospital Charge Code |
5685713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$972.83 |
| Max. Negotiated Rate |
$1,826.53 |
| Rate for Payer: Aetna Commercial |
$1,786.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.24
|
| Rate for Payer: Cash Price |
$572.70
|
| Rate for Payer: Cigna Commercial |
$1,826.53
|
| Rate for Payer: Health EOS Commercial |
$1,766.97
|
| Rate for Payer: HFN Commercial |
$1,826.53
|
| Rate for Payer: Multiplan Commercial |
$1,588.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,826.53
|
| Rate for Payer: Quartz Beloit One Network |
$972.83
|
| Rate for Payer: Quartz Commercial |
$1,191.22
|
| Rate for Payer: WEA Trust Commercial |
$1,091.95
|
| Rate for Payer: WPS Commercial |
$1,470.50
|
|
|
DRILL BIT 4.0MM X 200MM 5085-2-040
|
Facility
|
OP
|
$1,909.00
|
|
| Hospital Charge Code |
5685713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.90 |
| Max. Negotiated Rate |
$1,826.53 |
| Rate for Payer: Aetna Commercial |
$1,786.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.41
|
| Rate for Payer: Aetna Managed Medicare |
$555.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,290.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$992.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$952.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.24
|
| Rate for Payer: Cash Price |
$572.70
|
| Rate for Payer: Cigna Commercial |
$1,826.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.04
|
| Rate for Payer: Health EOS Commercial |
$1,766.97
|
| Rate for Payer: HFN Commercial |
$1,826.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,489.02
|
| Rate for Payer: Multiplan Commercial |
$1,588.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,826.53
|
| Rate for Payer: Quartz Beloit One Network |
$972.83
|
| Rate for Payer: Quartz Commercial |
$1,290.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,191.22
|
| Rate for Payer: The Alliance Commercial |
$992.68
|
| Rate for Payer: WEA Trust Commercial |
$1,091.95
|
| Rate for Payer: WPS Commercial |
$1,470.50
|
|
|
DRILL BIT 4.0 X 60MM ORTHOLOC 58850040
|
Facility
|
IP
|
$1,954.00
|
|
| Hospital Charge Code |
6206992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.76 |
| Max. Negotiated Rate |
$1,869.59 |
| Rate for Payer: Aetna Commercial |
$1,828.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,747.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.04
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$1,869.59
|
| Rate for Payer: Health EOS Commercial |
$1,808.62
|
| Rate for Payer: HFN Commercial |
$1,869.59
|
| Rate for Payer: Multiplan Commercial |
$1,625.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.59
|
| Rate for Payer: Quartz Beloit One Network |
$995.76
|
| Rate for Payer: Quartz Commercial |
$1,219.30
|
| Rate for Payer: WEA Trust Commercial |
$1,117.69
|
| Rate for Payer: WPS Commercial |
$1,505.17
|
|
|
DRILL BIT 4.0 X 60MM ORTHOLOC 58850040
|
Facility
|
OP
|
$1,954.00
|
|
| Hospital Charge Code |
6206992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.00 |
| Max. Negotiated Rate |
$1,869.59 |
| Rate for Payer: Aetna Commercial |
$1,828.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,747.66
|
| Rate for Payer: Aetna Managed Medicare |
$569.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.04
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$1,869.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.23
|
| Rate for Payer: Health EOS Commercial |
$1,808.62
|
| Rate for Payer: HFN Commercial |
$1,869.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.12
|
| Rate for Payer: Multiplan Commercial |
$1,625.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.59
|
| Rate for Payer: Quartz Beloit One Network |
$995.76
|
| Rate for Payer: Quartz Commercial |
$1,320.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.30
|
| Rate for Payer: The Alliance Commercial |
$1,016.08
|
| Rate for Payer: WEA Trust Commercial |
$1,117.69
|
| Rate for Payer: WPS Commercial |
$1,505.17
|
|
|
DRILL BIT 4.2 3-FLUTED NDL PT
|
Facility
|
IP
|
$2,945.00
|
|
| Hospital Charge Code |
2966206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
DRILL BIT 4.2 3-FLUTED NDL PT
|
Facility
|
OP
|
$2,945.00
|
|
| Hospital Charge Code |
2966206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.58 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$1,531.40
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
DRILL BIT 4.2 3-FLUTED NEEDLE POINT 03.010.104S
|
Facility
|
IP
|
$2,632.00
|
|
| Hospital Charge Code |
2966204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,341.27 |
| Max. Negotiated Rate |
$2,518.30 |
| Rate for Payer: Aetna Commercial |
$2,463.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,450.76
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$2,518.30
|
| Rate for Payer: Health EOS Commercial |
$2,436.18
|
| Rate for Payer: HFN Commercial |
$2,518.30
|
| Rate for Payer: Multiplan Commercial |
$2,189.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,518.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.27
|
| Rate for Payer: Quartz Commercial |
$1,642.37
|
| Rate for Payer: WEA Trust Commercial |
$1,505.50
|
| Rate for Payer: WPS Commercial |
$2,027.43
|
|
|
DRILL BIT 4.2 3-FLUTED NEEDLE POINT 03.010.104S
|
Facility
|
OP
|
$2,632.00
|
|
| Hospital Charge Code |
2966204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$766.44 |
| Max. Negotiated Rate |
$2,518.30 |
| Rate for Payer: Aetna Commercial |
$2,463.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.06
|
| Rate for Payer: Aetna Managed Medicare |
$766.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,779.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,368.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,313.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,450.76
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cigna Commercial |
$2,518.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,531.82
|
| Rate for Payer: Health EOS Commercial |
$2,436.18
|
| Rate for Payer: HFN Commercial |
$2,518.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,052.96
|
| Rate for Payer: Multiplan Commercial |
$2,189.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,642.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,518.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.27
|
| Rate for Payer: Quartz Commercial |
$1,779.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,642.37
|
| Rate for Payer: The Alliance Commercial |
$1,368.64
|
| Rate for Payer: WEA Trust Commercial |
$1,505.50
|
| Rate for Payer: WPS Commercial |
$2,027.43
|
|
|
DRILL BIT 4.2 CALIBRATED XTR-LG 03.045.022S
|
Facility
|
IP
|
$3,578.00
|
|
| Hospital Charge Code |
6175469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,823.35 |
| Max. Negotiated Rate |
$3,423.43 |
| Rate for Payer: Aetna Commercial |
$3,349.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,200.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,972.19
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$3,423.43
|
| Rate for Payer: Health EOS Commercial |
$3,311.80
|
| Rate for Payer: HFN Commercial |
$3,423.43
|
| Rate for Payer: Multiplan Commercial |
$2,976.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,423.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,823.35
|
| Rate for Payer: Quartz Commercial |
$2,232.67
|
| Rate for Payer: WEA Trust Commercial |
$2,046.62
|
| Rate for Payer: WPS Commercial |
$2,756.13
|
|
|
DRILL BIT 4.2 CALIBRATED XTR-LG 03.045.022S
|
Facility
|
OP
|
$3,578.00
|
|
| Hospital Charge Code |
6175469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,041.91 |
| Max. Negotiated Rate |
$3,423.43 |
| Rate for Payer: Aetna Commercial |
$3,349.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,200.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,041.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,418.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,860.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,786.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,972.19
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$3,423.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,082.40
|
| Rate for Payer: Health EOS Commercial |
$3,311.80
|
| Rate for Payer: HFN Commercial |
$3,423.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,790.84
|
| Rate for Payer: Multiplan Commercial |
$2,976.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,232.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,423.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,823.35
|
| Rate for Payer: Quartz Commercial |
$2,418.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,232.67
|
| Rate for Payer: The Alliance Commercial |
$1,860.56
|
| Rate for Payer: WEA Trust Commercial |
$2,046.62
|
| Rate for Payer: WPS Commercial |
$2,756.13
|
|
|
DRILL BIT 4.2MM 3-FLUTED 03.010.61S
|
Facility
|
OP
|
$3,457.00
|
|
| Hospital Charge Code |
2966207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.68 |
| Max. Negotiated Rate |
$3,307.66 |
| Rate for Payer: Aetna Commercial |
$3,235.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,006.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,336.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,797.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,725.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,905.50
|
| Rate for Payer: Cash Price |
$1,037.10
|
| Rate for Payer: Cigna Commercial |
$3,307.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,011.97
|
| Rate for Payer: Health EOS Commercial |
$3,199.80
|
| Rate for Payer: HFN Commercial |
$3,307.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,696.46
|
| Rate for Payer: Multiplan Commercial |
$2,876.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,157.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,307.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.69
|
| Rate for Payer: Quartz Commercial |
$2,336.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,157.17
|
| Rate for Payer: The Alliance Commercial |
$1,797.64
|
| Rate for Payer: WEA Trust Commercial |
$1,977.40
|
| Rate for Payer: WPS Commercial |
$2,662.93
|
|
|
DRILL BIT 4.2MM 3-FLUTED 03.010.61S
|
Facility
|
IP
|
$3,457.00
|
|
| Hospital Charge Code |
2966207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,761.69 |
| Max. Negotiated Rate |
$3,307.66 |
| Rate for Payer: Aetna Commercial |
$3,235.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,905.50
|
| Rate for Payer: Cash Price |
$1,037.10
|
| Rate for Payer: Cigna Commercial |
$3,307.66
|
| Rate for Payer: Health EOS Commercial |
$3,199.80
|
| Rate for Payer: HFN Commercial |
$3,307.66
|
| Rate for Payer: Multiplan Commercial |
$2,876.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,307.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.69
|
| Rate for Payer: Quartz Commercial |
$2,157.17
|
| Rate for Payer: WEA Trust Commercial |
$1,977.40
|
| Rate for Payer: WPS Commercial |
$2,662.93
|
|
|
DRILL BIT 4.2 RADIOLUCENT 4200-355-042
|
Facility
|
OP
|
$2,117.00
|
|
| Hospital Charge Code |
3287471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.47 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Aetna Commercial |
$1,981.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.44
|
| Rate for Payer: Aetna Managed Medicare |
$616.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,100.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.89
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$2,025.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.09
|
| Rate for Payer: Health EOS Commercial |
$1,959.50
|
| Rate for Payer: HFN Commercial |
$2,025.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,651.26
|
| Rate for Payer: Multiplan Commercial |
$1,761.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.82
|
| Rate for Payer: Quartz Commercial |
$1,431.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.01
|
| Rate for Payer: The Alliance Commercial |
$1,100.84
|
| Rate for Payer: WEA Trust Commercial |
$1,210.92
|
| Rate for Payer: WPS Commercial |
$1,630.73
|
|
|
DRILL BIT 4.2 RADIOLUCENT 4200-355-042
|
Facility
|
IP
|
$2,117.00
|
|
| Hospital Charge Code |
3287471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.82 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Aetna Commercial |
$1,981.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.89
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$2,025.55
|
| Rate for Payer: Health EOS Commercial |
$1,959.50
|
| Rate for Payer: HFN Commercial |
$2,025.55
|
| Rate for Payer: Multiplan Commercial |
$1,761.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.82
|
| Rate for Payer: Quartz Commercial |
$1,321.01
|
| Rate for Payer: WEA Trust Commercial |
$1,210.92
|
| Rate for Payer: WPS Commercial |
$1,630.73
|
|
|
DRILL BIT 4.2 X 130 AO 1806-4280S
|
Facility
|
IP
|
$3,326.00
|
|
| Hospital Charge Code |
4099049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,694.93 |
| Max. Negotiated Rate |
$3,182.32 |
| Rate for Payer: Aetna Commercial |
$3,113.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,974.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.29
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,182.32
|
| Rate for Payer: Health EOS Commercial |
$3,078.55
|
| Rate for Payer: HFN Commercial |
$3,182.32
|
| Rate for Payer: Multiplan Commercial |
$2,767.23
|
| Rate for Payer: Preferred Network Access Commercial |
$3,182.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.93
|
| Rate for Payer: Quartz Commercial |
$2,075.42
|
| Rate for Payer: WEA Trust Commercial |
$1,902.47
|
| Rate for Payer: WPS Commercial |
$2,562.02
|
|
|
DRILL BIT 4.2 X 130 AO 1806-4280S
|
Facility
|
OP
|
$3,326.00
|
|
| Hospital Charge Code |
4099049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.53 |
| Max. Negotiated Rate |
$3,182.32 |
| Rate for Payer: Aetna Commercial |
$3,113.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,974.77
|
| Rate for Payer: Aetna Managed Medicare |
$968.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,248.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,729.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,660.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.29
|
| Rate for Payer: Cash Price |
$997.80
|
| Rate for Payer: Cigna Commercial |
$3,182.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,935.73
|
| Rate for Payer: Health EOS Commercial |
$3,078.55
|
| Rate for Payer: HFN Commercial |
$3,182.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,594.28
|
| Rate for Payer: Multiplan Commercial |
$2,767.23
|
| Rate for Payer: NAPHCARE Commercial |
$2,075.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,182.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.93
|
| Rate for Payer: Quartz Commercial |
$2,248.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,075.42
|
| Rate for Payer: The Alliance Commercial |
$1,729.52
|
| Rate for Payer: WEA Trust Commercial |
$1,902.47
|
| Rate for Payer: WPS Commercial |
$2,562.02
|
|
|
DRILL BIT 4.2 X 230 AO 1806-4290S
|
Facility
|
OP
|
$1,379.00
|
|
| Hospital Charge Code |
5583321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.56 |
| Max. Negotiated Rate |
$1,319.43 |
| Rate for Payer: Aetna Commercial |
$1,290.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.38
|
| Rate for Payer: Aetna Managed Medicare |
$401.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.10
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,319.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$802.58
|
| Rate for Payer: Health EOS Commercial |
$1,276.40
|
| Rate for Payer: HFN Commercial |
$1,319.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,075.62
|
| Rate for Payer: Multiplan Commercial |
$1,147.33
|
| Rate for Payer: NAPHCARE Commercial |
$860.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.43
|
| Rate for Payer: Quartz Beloit One Network |
$702.74
|
| Rate for Payer: Quartz Commercial |
$932.20
|
| Rate for Payer: Quartz Medicare Advantage |
$860.50
|
| Rate for Payer: The Alliance Commercial |
$717.08
|
| Rate for Payer: WEA Trust Commercial |
$788.79
|
| Rate for Payer: WPS Commercial |
$1,062.24
|
|
|
DRILL BIT 4.2 X 230 AO 1806-4290S
|
Facility
|
IP
|
$1,379.00
|
|
| Hospital Charge Code |
5583321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.74 |
| Max. Negotiated Rate |
$1,319.43 |
| Rate for Payer: Aetna Commercial |
$1,290.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.10
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,319.43
|
| Rate for Payer: Health EOS Commercial |
$1,276.40
|
| Rate for Payer: HFN Commercial |
$1,319.43
|
| Rate for Payer: Multiplan Commercial |
$1,147.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.43
|
| Rate for Payer: Quartz Beloit One Network |
$702.74
|
| Rate for Payer: Quartz Commercial |
$860.50
|
| Rate for Payer: WEA Trust Commercial |
$788.79
|
| Rate for Payer: WPS Commercial |
$1,062.24
|
|
|
DRILL BIT 4.2 X 340MM STRYKER 1806-4260S
|
Facility
|
OP
|
$2,544.00
|
|
| Hospital Charge Code |
3072607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.81 |
| Max. Negotiated Rate |
$2,434.10 |
| Rate for Payer: Aetna Commercial |
$2,381.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,275.35
|
| Rate for Payer: Aetna Managed Medicare |
$740.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,719.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,322.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,269.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,402.25
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,434.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,480.61
|
| Rate for Payer: Health EOS Commercial |
$2,354.73
|
| Rate for Payer: HFN Commercial |
$2,434.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,984.32
|
| Rate for Payer: Multiplan Commercial |
$2,116.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,587.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.42
|
| Rate for Payer: Quartz Commercial |
$1,719.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,587.46
|
| Rate for Payer: The Alliance Commercial |
$1,322.88
|
| Rate for Payer: WEA Trust Commercial |
$1,455.17
|
| Rate for Payer: WPS Commercial |
$1,959.64
|
|
|
DRILL BIT 4.2 X 340MM STRYKER 1806-4260S
|
Facility
|
IP
|
$2,544.00
|
|
| Hospital Charge Code |
3072607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,296.42 |
| Max. Negotiated Rate |
$2,434.10 |
| Rate for Payer: Aetna Commercial |
$2,381.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,275.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,402.25
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,434.10
|
| Rate for Payer: Health EOS Commercial |
$2,354.73
|
| Rate for Payer: HFN Commercial |
$2,434.10
|
| Rate for Payer: Multiplan Commercial |
$2,116.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.42
|
| Rate for Payer: Quartz Commercial |
$1,587.46
|
| Rate for Payer: WEA Trust Commercial |
$1,455.17
|
| Rate for Payer: WPS Commercial |
$1,959.64
|
|
|
DRILL BIT 4.3MM X 413MM 03.168.011
|
Facility
|
IP
|
$3,922.00
|
|
| Hospital Charge Code |
6178979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,998.65 |
| Max. Negotiated Rate |
$3,752.57 |
| Rate for Payer: Aetna Commercial |
$3,670.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,507.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,161.81
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,752.57
|
| Rate for Payer: Health EOS Commercial |
$3,630.20
|
| Rate for Payer: HFN Commercial |
$3,752.57
|
| Rate for Payer: Multiplan Commercial |
$3,263.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,752.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,998.65
|
| Rate for Payer: Quartz Commercial |
$2,447.33
|
| Rate for Payer: WEA Trust Commercial |
$2,243.38
|
| Rate for Payer: WPS Commercial |
$3,021.12
|
|
|
DRILL BIT 4.3MM X 413MM 03.168.011
|
Facility
|
OP
|
$3,922.00
|
|
| Hospital Charge Code |
6178979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,142.09 |
| Max. Negotiated Rate |
$3,752.57 |
| Rate for Payer: Aetna Commercial |
$3,670.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,507.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,142.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,651.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,039.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,957.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,161.81
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,752.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,282.60
|
| Rate for Payer: Health EOS Commercial |
$3,630.20
|
| Rate for Payer: HFN Commercial |
$3,752.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,059.16
|
| Rate for Payer: Multiplan Commercial |
$3,263.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,447.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,752.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,998.65
|
| Rate for Payer: Quartz Commercial |
$2,651.27
|
| Rate for Payer: Quartz Medicare Advantage |
$2,447.33
|
| Rate for Payer: The Alliance Commercial |
$2,039.44
|
| Rate for Payer: WEA Trust Commercial |
$2,243.38
|
| Rate for Payer: WPS Commercial |
$3,021.12
|
|
|
DRILL BIT 4.3 PERCUTANEOUS 324.213
|
Facility
|
OP
|
$2,807.00
|
|
| Hospital Charge Code |
2966208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.40 |
| Max. Negotiated Rate |
$2,685.74 |
| Rate for Payer: Aetna Commercial |
$2,627.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,510.58
|
| Rate for Payer: Aetna Managed Medicare |
$817.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,897.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,459.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,401.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.22
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,685.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,633.67
|
| Rate for Payer: Health EOS Commercial |
$2,598.16
|
| Rate for Payer: HFN Commercial |
$2,685.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,189.46
|
| Rate for Payer: Multiplan Commercial |
$2,335.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,751.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,685.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.45
|
| Rate for Payer: Quartz Commercial |
$1,897.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,751.57
|
| Rate for Payer: The Alliance Commercial |
$1,459.64
|
| Rate for Payer: WEA Trust Commercial |
$1,605.60
|
| Rate for Payer: WPS Commercial |
$2,162.23
|
|
