|
DRILL BIT 4.3 PERCUTANEOUS 324.213
|
Facility
|
IP
|
$2,807.00
|
|
| Hospital Charge Code |
2966208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,430.45 |
| 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: 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: Health EOS Commercial |
$2,598.16
|
| Rate for Payer: HFN Commercial |
$2,685.74
|
| Rate for Payer: Multiplan Commercial |
$2,335.42
|
| 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 |
$1,751.57
|
| Rate for Payer: WEA Trust Commercial |
$1,605.60
|
| Rate for Payer: WPS Commercial |
$2,162.23
|
|
|
DRILL BIT 4.3 X 180 QUICK COUPLE 310.431
|
Facility
|
OP
|
$1,832.00
|
|
| Hospital Charge Code |
2966209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.48 |
| Max. Negotiated Rate |
$1,752.86 |
| Rate for Payer: Aetna Commercial |
$1,714.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,638.54
|
| Rate for Payer: Aetna Managed Medicare |
$533.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,238.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$914.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.80
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,752.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,066.22
|
| Rate for Payer: Health EOS Commercial |
$1,695.70
|
| Rate for Payer: HFN Commercial |
$1,752.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.96
|
| Rate for Payer: Multiplan Commercial |
$1,524.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,752.86
|
| Rate for Payer: Quartz Beloit One Network |
$933.59
|
| Rate for Payer: Quartz Commercial |
$1,238.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,143.17
|
| Rate for Payer: The Alliance Commercial |
$952.64
|
| Rate for Payer: WEA Trust Commercial |
$1,047.90
|
| Rate for Payer: WPS Commercial |
$1,411.19
|
|
|
DRILL BIT 4.3 X 180 QUICK COUPLE 310.431
|
Facility
|
IP
|
$1,832.00
|
|
| Hospital Charge Code |
2966209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$933.59 |
| Max. Negotiated Rate |
$1,752.86 |
| Rate for Payer: Aetna Commercial |
$1,714.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,638.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.80
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,752.86
|
| Rate for Payer: Health EOS Commercial |
$1,695.70
|
| Rate for Payer: HFN Commercial |
$1,752.86
|
| Rate for Payer: Multiplan Commercial |
$1,524.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,752.86
|
| Rate for Payer: Quartz Beloit One Network |
$933.59
|
| Rate for Payer: Quartz Commercial |
$1,143.17
|
| Rate for Payer: WEA Trust Commercial |
$1,047.90
|
| Rate for Payer: WPS Commercial |
$1,411.19
|
|
|
DRILL BIT 4.3 X 216MM LOCKING SHORT 705043
|
Facility
|
OP
|
$4,452.00
|
|
| Hospital Charge Code |
5458804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,296.42 |
| Max. Negotiated Rate |
$4,259.67 |
| Rate for Payer: Aetna Commercial |
$4,167.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,981.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,296.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,009.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,315.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,222.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,453.94
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,259.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,591.06
|
| Rate for Payer: Health EOS Commercial |
$4,120.77
|
| Rate for Payer: HFN Commercial |
$4,259.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,472.56
|
| Rate for Payer: Multiplan Commercial |
$3,704.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,778.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,259.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,268.74
|
| Rate for Payer: Quartz Commercial |
$3,009.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,778.05
|
| Rate for Payer: The Alliance Commercial |
$2,315.04
|
| Rate for Payer: WEA Trust Commercial |
$2,546.54
|
| Rate for Payer: WPS Commercial |
$3,429.38
|
|
|
DRILL BIT 4.3 X 216MM LOCKING SHORT 705043
|
Facility
|
IP
|
$4,452.00
|
|
| Hospital Charge Code |
5458804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,268.74 |
| Max. Negotiated Rate |
$4,259.67 |
| Rate for Payer: Aetna Commercial |
$4,167.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,981.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,453.94
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna Commercial |
$4,259.67
|
| Rate for Payer: Health EOS Commercial |
$4,120.77
|
| Rate for Payer: HFN Commercial |
$4,259.67
|
| Rate for Payer: Multiplan Commercial |
$3,704.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,259.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,268.74
|
| Rate for Payer: Quartz Commercial |
$2,778.05
|
| Rate for Payer: WEA Trust Commercial |
$2,546.54
|
| Rate for Payer: WPS Commercial |
$3,429.38
|
|
|
DRILL BIT 4.3 X 296MM LOCKING MEDIUM 705078
|
Facility
|
IP
|
$4,404.00
|
|
| Hospital Charge Code |
5106958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,244.28 |
| Max. Negotiated Rate |
$4,213.75 |
| Rate for Payer: Aetna Commercial |
$4,122.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,427.48
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,213.75
|
| Rate for Payer: Health EOS Commercial |
$4,076.34
|
| Rate for Payer: HFN Commercial |
$4,213.75
|
| Rate for Payer: Multiplan Commercial |
$3,664.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,213.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,244.28
|
| Rate for Payer: Quartz Commercial |
$2,748.10
|
| Rate for Payer: WEA Trust Commercial |
$2,519.09
|
| Rate for Payer: WPS Commercial |
$3,392.40
|
|
|
DRILL BIT 4.3 X 296MM LOCKING MEDIUM 705078
|
Facility
|
OP
|
$4,404.00
|
|
| Hospital Charge Code |
5106958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,282.44 |
| Max. Negotiated Rate |
$4,213.75 |
| Rate for Payer: Aetna Commercial |
$4,122.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,282.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,977.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,290.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,198.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,427.48
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,213.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,563.13
|
| Rate for Payer: Health EOS Commercial |
$4,076.34
|
| Rate for Payer: HFN Commercial |
$4,213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,435.12
|
| Rate for Payer: Multiplan Commercial |
$3,664.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,748.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,213.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,244.28
|
| Rate for Payer: Quartz Commercial |
$2,977.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,748.10
|
| Rate for Payer: The Alliance Commercial |
$2,290.08
|
| Rate for Payer: WEA Trust Commercial |
$2,519.09
|
| Rate for Payer: WPS Commercial |
$3,392.40
|
|
|
DRILL BIT 4.5MM 310.48
|
Facility
|
OP
|
$1,897.00
|
|
| Hospital Charge Code |
2966212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,815.05 |
| Rate for Payer: Aetna Commercial |
$1,775.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.68
|
| Rate for Payer: Aetna Managed Medicare |
$552.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,282.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$986.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,045.63
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,815.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,104.05
|
| Rate for Payer: Health EOS Commercial |
$1,755.86
|
| Rate for Payer: HFN Commercial |
$1,815.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,479.66
|
| Rate for Payer: Multiplan Commercial |
$1,578.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,183.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,815.05
|
| Rate for Payer: Quartz Beloit One Network |
$966.71
|
| Rate for Payer: Quartz Commercial |
$1,282.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,183.73
|
| Rate for Payer: The Alliance Commercial |
$986.44
|
| Rate for Payer: WEA Trust Commercial |
$1,085.08
|
| Rate for Payer: WPS Commercial |
$1,461.26
|
|
|
DRILL BIT 4.5MM 310.48
|
Facility
|
IP
|
$1,897.00
|
|
| Hospital Charge Code |
2966212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$966.71 |
| Max. Negotiated Rate |
$1,815.05 |
| Rate for Payer: Aetna Commercial |
$1,775.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,045.63
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,815.05
|
| Rate for Payer: Health EOS Commercial |
$1,755.86
|
| Rate for Payer: HFN Commercial |
$1,815.05
|
| Rate for Payer: Multiplan Commercial |
$1,578.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,815.05
|
| Rate for Payer: Quartz Beloit One Network |
$966.71
|
| Rate for Payer: Quartz Commercial |
$1,183.73
|
| Rate for Payer: WEA Trust Commercial |
$1,085.08
|
| Rate for Payer: WPS Commercial |
$1,461.26
|
|
|
DRILL BIT 4.5MM LONG AR-8970-45L
|
Facility
|
IP
|
$1,920.00
|
|
| Hospital Charge Code |
5803669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,198.08
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
DRILL BIT 4.5MM LONG AR-8970-45L
|
Facility
|
OP
|
$1,920.00
|
|
| Hospital Charge Code |
5803669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.10 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Aetna Managed Medicare |
$559.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,297.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.44
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.60
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.08
|
| Rate for Payer: The Alliance Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
DRILL BIT 4.5MM SPADE PILOT 214-00-007
|
Facility
|
OP
|
$3,048.00
|
|
| Hospital Charge Code |
3737515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.58 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Aetna Managed Medicare |
$887.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,060.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,584.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,521.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,773.94
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,377.44
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,901.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$2,060.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,901.95
|
| Rate for Payer: The Alliance Commercial |
$1,584.96
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
DRILL BIT 4.5MM SPADE PILOT 214-00-007
|
Facility
|
IP
|
$3,048.00
|
|
| Hospital Charge Code |
3737515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,553.26 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$1,901.95
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
DRILL BIT 4.5MM X12.7CM 00-2318-045-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
5349274
|
|
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 4.5MM X12.7CM 00-2318-045-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
5349274
|
|
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 4.5 QUICK COUPLING 310.44
|
Facility
|
IP
|
$1,372.00
|
|
| Hospital Charge Code |
2966210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.17 |
| Max. Negotiated Rate |
$1,312.73 |
| Rate for Payer: Aetna Commercial |
$1,284.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.25
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,312.73
|
| Rate for Payer: Health EOS Commercial |
$1,269.92
|
| Rate for Payer: HFN Commercial |
$1,312.73
|
| Rate for Payer: Multiplan Commercial |
$1,141.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.73
|
| Rate for Payer: Quartz Beloit One Network |
$699.17
|
| Rate for Payer: Quartz Commercial |
$856.13
|
| Rate for Payer: WEA Trust Commercial |
$784.78
|
| Rate for Payer: WPS Commercial |
$1,056.85
|
|
|
DRILL BIT 4.5 QUICK COUPLING 310.44
|
Facility
|
OP
|
$1,372.00
|
|
| Hospital Charge Code |
2966210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$1,312.73 |
| Rate for Payer: Aetna Commercial |
$1,284.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.12
|
| Rate for Payer: Aetna Managed Medicare |
$399.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$927.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.25
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,312.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$798.50
|
| Rate for Payer: Health EOS Commercial |
$1,269.92
|
| Rate for Payer: HFN Commercial |
$1,312.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.16
|
| Rate for Payer: Multiplan Commercial |
$1,141.50
|
| Rate for Payer: NAPHCARE Commercial |
$856.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.73
|
| Rate for Payer: Quartz Beloit One Network |
$699.17
|
| Rate for Payer: Quartz Commercial |
$927.47
|
| Rate for Payer: Quartz Medicare Advantage |
$856.13
|
| Rate for Payer: The Alliance Commercial |
$713.44
|
| Rate for Payer: WEA Trust Commercial |
$784.78
|
| Rate for Payer: WPS Commercial |
$1,056.85
|
|
|
DRILL BIT 4.5 W/STOP
|
Facility
|
IP
|
$4,522.00
|
|
| Hospital Charge Code |
2966211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,304.41 |
| Max. Negotiated Rate |
$4,326.65 |
| Rate for Payer: Aetna Commercial |
$4,232.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,044.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,492.53
|
| Rate for Payer: Cash Price |
$1,356.60
|
| Rate for Payer: Cigna Commercial |
$4,326.65
|
| Rate for Payer: Health EOS Commercial |
$4,185.56
|
| Rate for Payer: HFN Commercial |
$4,326.65
|
| Rate for Payer: Multiplan Commercial |
$3,762.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,326.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,304.41
|
| Rate for Payer: Quartz Commercial |
$2,821.73
|
| Rate for Payer: WEA Trust Commercial |
$2,586.58
|
| Rate for Payer: WPS Commercial |
$3,483.30
|
|
|
DRILL BIT 4.5 W/STOP
|
Facility
|
OP
|
$4,522.00
|
|
| Hospital Charge Code |
2966211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.81 |
| Max. Negotiated Rate |
$4,326.65 |
| Rate for Payer: Aetna Commercial |
$4,232.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,044.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,316.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,056.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,351.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,257.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,492.53
|
| Rate for Payer: Cash Price |
$1,356.60
|
| Rate for Payer: Cigna Commercial |
$4,326.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,631.80
|
| Rate for Payer: Health EOS Commercial |
$4,185.56
|
| Rate for Payer: HFN Commercial |
$4,326.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,527.16
|
| Rate for Payer: Multiplan Commercial |
$3,762.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,326.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,304.41
|
| Rate for Payer: Quartz Commercial |
$3,056.87
|
| Rate for Payer: Quartz Medicare Advantage |
$2,821.73
|
| Rate for Payer: The Alliance Commercial |
$2,351.44
|
| Rate for Payer: WEA Trust Commercial |
$2,586.58
|
| Rate for Payer: WPS Commercial |
$3,483.30
|
|
|
DRILL BIT 4.8MM X12.7CM 3/16 00-2318-048-06
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
2967405
|
|
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 4.8MM X12.7CM 3/16 00-2318-048-06
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
2967405
|
|
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 4.9MM AO FITTING 705252
|
Facility
|
OP
|
$3,338.00
|
|
| Hospital Charge Code |
5641644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$972.03 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$972.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,256.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,735.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,666.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,942.72
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,603.64
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,082.91
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,256.49
|
| Rate for Payer: Quartz Medicare Advantage |
$2,082.91
|
| Rate for Payer: The Alliance Commercial |
$1,735.76
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
DRILL BIT 4.9MM AO FITTING 705252
|
Facility
|
IP
|
$3,338.00
|
|
| Hospital Charge Code |
5641644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,701.04 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,082.91
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
DRILL BIT 5.0MM 3-FLUTED
|
Facility
|
IP
|
$3,373.00
|
|
| Hospital Charge Code |
2966214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,718.88 |
| Max. Negotiated Rate |
$3,227.29 |
| Rate for Payer: Aetna Commercial |
$3,157.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,016.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,011.90
|
| Rate for Payer: Cigna Commercial |
$3,227.29
|
| Rate for Payer: Health EOS Commercial |
$3,122.05
|
| Rate for Payer: HFN Commercial |
$3,227.29
|
| Rate for Payer: Multiplan Commercial |
$2,806.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,227.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.88
|
| Rate for Payer: Quartz Commercial |
$2,104.75
|
| Rate for Payer: WEA Trust Commercial |
$1,929.36
|
| Rate for Payer: WPS Commercial |
$2,598.22
|
|
|
DRILL BIT 5.0MM 3-FLUTED
|
Facility
|
OP
|
$3,373.00
|
|
| Hospital Charge Code |
2966214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$982.22 |
| Max. Negotiated Rate |
$3,227.29 |
| Rate for Payer: Aetna Commercial |
$3,157.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,016.81
|
| Rate for Payer: Aetna Managed Medicare |
$982.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,753.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,683.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,011.90
|
| Rate for Payer: Cigna Commercial |
$3,227.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,963.09
|
| Rate for Payer: Health EOS Commercial |
$3,122.05
|
| Rate for Payer: HFN Commercial |
$3,227.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,630.94
|
| Rate for Payer: Multiplan Commercial |
$2,806.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,104.75
|
| Rate for Payer: Preferred Network Access Commercial |
$3,227.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.88
|
| Rate for Payer: Quartz Commercial |
$2,280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,104.75
|
| Rate for Payer: The Alliance Commercial |
$1,753.96
|
| Rate for Payer: WEA Trust Commercial |
$1,929.36
|
| Rate for Payer: WPS Commercial |
$2,598.22
|
|
