|
DRILL BIT 2.8MM CALIBRATED 95MM 03.113.024
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
3265479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.11 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$453.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.59
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.68
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$1,051.86
|
| Rate for Payer: Quartz Medicare Advantage |
$970.94
|
| Rate for Payer: The Alliance Commercial |
$809.12
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
DRILL BIT 2.8MM CALIBRATED 95MM 03.113.024
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
3265479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
DRILL BIT 2.8MM PERCUTANEOUS 324.214
|
Facility
|
OP
|
$2,903.00
|
|
| Hospital Charge Code |
2966192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.35 |
| Max. Negotiated Rate |
$2,777.59 |
| Rate for Payer: Aetna Commercial |
$2,717.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,596.44
|
| Rate for Payer: Aetna Managed Medicare |
$845.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,962.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,449.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.13
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,777.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,689.55
|
| Rate for Payer: Health EOS Commercial |
$2,687.02
|
| Rate for Payer: HFN Commercial |
$2,777.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,264.34
|
| Rate for Payer: Multiplan Commercial |
$2,415.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,811.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,777.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.37
|
| Rate for Payer: Quartz Commercial |
$1,962.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,811.47
|
| Rate for Payer: The Alliance Commercial |
$1,509.56
|
| Rate for Payer: WEA Trust Commercial |
$1,660.52
|
| Rate for Payer: WPS Commercial |
$2,236.18
|
|
|
DRILL BIT 2.8MM PERCUTANEOUS 324.214
|
Facility
|
IP
|
$2,903.00
|
|
| Hospital Charge Code |
2966192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,479.37 |
| Max. Negotiated Rate |
$2,777.59 |
| Rate for Payer: Aetna Commercial |
$2,717.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,596.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.13
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,777.59
|
| Rate for Payer: Health EOS Commercial |
$2,687.02
|
| Rate for Payer: HFN Commercial |
$2,777.59
|
| Rate for Payer: Multiplan Commercial |
$2,415.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,777.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.37
|
| Rate for Payer: Quartz Commercial |
$1,811.47
|
| Rate for Payer: WEA Trust Commercial |
$1,660.52
|
| Rate for Payer: WPS Commercial |
$2,236.18
|
|
|
DRILL BIT 2.8MM X 5 IN QUICK RELEASE 80-2008
|
Facility
|
OP
|
$2,118.00
|
|
| Hospital Charge Code |
6181298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.76 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,982.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.34
|
| Rate for Payer: Aetna Managed Medicare |
$616.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,057.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.44
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$2,026.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.68
|
| Rate for Payer: Health EOS Commercial |
$1,960.42
|
| Rate for Payer: HFN Commercial |
$2,026.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,652.04
|
| Rate for Payer: Multiplan Commercial |
$1,762.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.33
|
| Rate for Payer: Quartz Commercial |
$1,431.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.63
|
| Rate for Payer: The Alliance Commercial |
$1,101.36
|
| Rate for Payer: WEA Trust Commercial |
$1,211.50
|
| Rate for Payer: WPS Commercial |
$1,631.50
|
|
|
DRILL BIT 2.8MM X 5 IN QUICK RELEASE 80-2008
|
Facility
|
IP
|
$2,118.00
|
|
| Hospital Charge Code |
6181298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,079.33 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,982.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.44
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$2,026.50
|
| Rate for Payer: Health EOS Commercial |
$1,960.42
|
| Rate for Payer: HFN Commercial |
$2,026.50
|
| Rate for Payer: Multiplan Commercial |
$1,762.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.33
|
| Rate for Payer: Quartz Commercial |
$1,321.63
|
| Rate for Payer: WEA Trust Commercial |
$1,211.50
|
| Rate for Payer: WPS Commercial |
$1,631.50
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.106
|
Facility
|
IP
|
$1,642.42
|
|
| Hospital Charge Code |
6220226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.98 |
| Max. Negotiated Rate |
$1,571.47 |
| Rate for Payer: Aetna Commercial |
$1,537.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.30
|
| Rate for Payer: Cash Price |
$492.73
|
| Rate for Payer: Cigna Commercial |
$1,571.47
|
| Rate for Payer: Health EOS Commercial |
$1,520.22
|
| Rate for Payer: HFN Commercial |
$1,571.47
|
| Rate for Payer: Multiplan Commercial |
$1,366.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.47
|
| Rate for Payer: Quartz Beloit One Network |
$836.98
|
| Rate for Payer: Quartz Commercial |
$1,024.87
|
| Rate for Payer: WEA Trust Commercial |
$939.46
|
| Rate for Payer: WPS Commercial |
$1,265.16
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.106
|
Facility
|
OP
|
$1,642.42
|
|
| Hospital Charge Code |
6220226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.27 |
| Max. Negotiated Rate |
$1,571.47 |
| Rate for Payer: Aetna Commercial |
$1,537.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.98
|
| Rate for Payer: Aetna Managed Medicare |
$478.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.30
|
| Rate for Payer: Cash Price |
$492.73
|
| Rate for Payer: Cigna Commercial |
$1,571.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.89
|
| Rate for Payer: Health EOS Commercial |
$1,520.22
|
| Rate for Payer: HFN Commercial |
$1,571.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.09
|
| Rate for Payer: Multiplan Commercial |
$1,366.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.47
|
| Rate for Payer: Quartz Beloit One Network |
$836.98
|
| Rate for Payer: Quartz Commercial |
$1,110.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.87
|
| Rate for Payer: The Alliance Commercial |
$854.06
|
| Rate for Payer: WEA Trust Commercial |
$939.46
|
| Rate for Payer: WPS Commercial |
$1,265.16
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.107
|
Facility
|
IP
|
$2,032.00
|
|
| Hospital Charge Code |
6234157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,035.51 |
| Max. Negotiated Rate |
$1,944.22 |
| Rate for Payer: Aetna Commercial |
$1,901.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.04
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$1,944.22
|
| Rate for Payer: Health EOS Commercial |
$1,880.82
|
| Rate for Payer: HFN Commercial |
$1,944.22
|
| Rate for Payer: Multiplan Commercial |
$1,690.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,944.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.51
|
| Rate for Payer: Quartz Commercial |
$1,267.97
|
| Rate for Payer: WEA Trust Commercial |
$1,162.30
|
| Rate for Payer: WPS Commercial |
$1,565.25
|
|
|
DRILL BIT 2.8 QUICK COUPLE 03.133.107
|
Facility
|
OP
|
$2,032.00
|
|
| Hospital Charge Code |
6234157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.72 |
| Max. Negotiated Rate |
$1,944.22 |
| Rate for Payer: Aetna Commercial |
$1,901.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.42
|
| Rate for Payer: Aetna Managed Medicare |
$591.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,373.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,014.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.04
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cigna Commercial |
$1,944.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.62
|
| Rate for Payer: Health EOS Commercial |
$1,880.82
|
| Rate for Payer: HFN Commercial |
$1,944.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.96
|
| Rate for Payer: Multiplan Commercial |
$1,690.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,944.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.51
|
| Rate for Payer: Quartz Commercial |
$1,373.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.97
|
| Rate for Payer: The Alliance Commercial |
$1,056.64
|
| Rate for Payer: WEA Trust Commercial |
$1,162.30
|
| Rate for Payer: WPS Commercial |
$1,565.25
|
|
|
DRILL BIT 2.8 QUICK COUPLING 310.288
|
Facility
|
IP
|
$1,637.00
|
|
| Hospital Charge Code |
2966191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$834.22 |
| Max. Negotiated Rate |
$1,566.28 |
| Rate for Payer: Aetna Commercial |
$1,532.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,464.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$902.31
|
| Rate for Payer: Cash Price |
$491.10
|
| Rate for Payer: Cigna Commercial |
$1,566.28
|
| Rate for Payer: Health EOS Commercial |
$1,515.21
|
| Rate for Payer: HFN Commercial |
$1,566.28
|
| Rate for Payer: Multiplan Commercial |
$1,361.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,566.28
|
| Rate for Payer: Quartz Beloit One Network |
$834.22
|
| Rate for Payer: Quartz Commercial |
$1,021.49
|
| Rate for Payer: WEA Trust Commercial |
$936.36
|
| Rate for Payer: WPS Commercial |
$1,260.98
|
|
|
DRILL BIT 2.8 QUICK COUPLING 310.288
|
Facility
|
OP
|
$1,637.00
|
|
| Hospital Charge Code |
2966191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.69 |
| Max. Negotiated Rate |
$1,566.28 |
| Rate for Payer: Aetna Commercial |
$1,532.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,464.13
|
| Rate for Payer: Aetna Managed Medicare |
$476.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,106.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$851.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$817.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$902.31
|
| Rate for Payer: Cash Price |
$491.10
|
| Rate for Payer: Cigna Commercial |
$1,566.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$952.73
|
| Rate for Payer: Health EOS Commercial |
$1,515.21
|
| Rate for Payer: HFN Commercial |
$1,566.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,276.86
|
| Rate for Payer: Multiplan Commercial |
$1,361.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,021.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,566.28
|
| Rate for Payer: Quartz Beloit One Network |
$834.22
|
| Rate for Payer: Quartz Commercial |
$1,106.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,021.49
|
| Rate for Payer: The Alliance Commercial |
$851.24
|
| Rate for Payer: WEA Trust Commercial |
$936.36
|
| Rate for Payer: WPS Commercial |
$1,260.98
|
|
|
DRILL BIT 2.8 SHORT
|
Facility
|
OP
|
$1,217.00
|
|
| Hospital Charge Code |
2964139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.39 |
| Max. Negotiated Rate |
$1,164.43 |
| Rate for Payer: Aetna Commercial |
$1,139.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.48
|
| Rate for Payer: Aetna Managed Medicare |
$354.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.81
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,164.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.29
|
| Rate for Payer: Health EOS Commercial |
$1,126.46
|
| Rate for Payer: HFN Commercial |
$1,164.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$949.26
|
| Rate for Payer: Multiplan Commercial |
$1,012.54
|
| Rate for Payer: NAPHCARE Commercial |
$759.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.43
|
| Rate for Payer: Quartz Beloit One Network |
$620.18
|
| Rate for Payer: Quartz Commercial |
$822.69
|
| Rate for Payer: Quartz Medicare Advantage |
$759.41
|
| Rate for Payer: The Alliance Commercial |
$632.84
|
| Rate for Payer: WEA Trust Commercial |
$696.12
|
| Rate for Payer: WPS Commercial |
$937.46
|
|
|
DRILL BIT 2.8 SHORT
|
Facility
|
IP
|
$1,217.00
|
|
| Hospital Charge Code |
2964139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.18 |
| Max. Negotiated Rate |
$1,164.43 |
| Rate for Payer: Aetna Commercial |
$1,139.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.81
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,164.43
|
| Rate for Payer: Health EOS Commercial |
$1,126.46
|
| Rate for Payer: HFN Commercial |
$1,164.43
|
| Rate for Payer: Multiplan Commercial |
$1,012.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.43
|
| Rate for Payer: Quartz Beloit One Network |
$620.18
|
| Rate for Payer: Quartz Commercial |
$759.41
|
| Rate for Payer: WEA Trust Commercial |
$696.12
|
| Rate for Payer: WPS Commercial |
$937.46
|
|
|
DRILL BIT 2.8 X 60MM ORTHOLOC 58850028
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5729840
|
|
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 2.8 X 60MM ORTHOLOC 58850028
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5729840
|
|
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 IN 1 CANNULATED ATTACHMENT 159023SND
|
Facility
|
OP
|
$2,604.00
|
|
| Hospital Charge Code |
5617666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$758.28 |
| Max. Negotiated Rate |
$2,491.51 |
| Rate for Payer: Aetna Commercial |
$2,437.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,329.02
|
| Rate for Payer: Aetna Managed Medicare |
$758.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,760.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,354.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,299.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,435.32
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$2,491.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,515.53
|
| Rate for Payer: Health EOS Commercial |
$2,410.26
|
| Rate for Payer: HFN Commercial |
$2,491.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,031.12
|
| Rate for Payer: Multiplan Commercial |
$2,166.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,327.00
|
| Rate for Payer: Quartz Commercial |
$1,760.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.90
|
| Rate for Payer: The Alliance Commercial |
$1,354.08
|
| Rate for Payer: WEA Trust Commercial |
$1,489.49
|
| Rate for Payer: WPS Commercial |
$2,005.86
|
|
|
DRILL BIT 2 IN 1 CANNULATED ATTACHMENT 159023SND
|
Facility
|
IP
|
$2,604.00
|
|
| Hospital Charge Code |
5617666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,327.00 |
| Max. Negotiated Rate |
$2,491.51 |
| Rate for Payer: Aetna Commercial |
$2,437.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,329.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,435.32
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$2,491.51
|
| Rate for Payer: Health EOS Commercial |
$2,410.26
|
| Rate for Payer: HFN Commercial |
$2,491.51
|
| Rate for Payer: Multiplan Commercial |
$2,166.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,327.00
|
| Rate for Payer: Quartz Commercial |
$1,624.90
|
| Rate for Payer: WEA Trust Commercial |
$1,489.49
|
| Rate for Payer: WPS Commercial |
$2,005.86
|
|
|
DRILL BIT 2MM CANN AR-8933-20C
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5415811
|
|
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 2MM CANN AR-8933-20C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5415811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
DRILL BIT 3.0 MGS STERILE AR-9628S
|
Facility
|
OP
|
$3,139.00
|
|
| Hospital Charge Code |
5603575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
DRILL BIT 3.0 MGS STERILE AR-9628S
|
Facility
|
IP
|
$3,139.00
|
|
| Hospital Charge Code |
5603575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.63 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$1,958.74
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
DRILL BIT 3.0MM AR-8943-36
|
Facility
|
OP
|
$1,531.00
|
|
| Hospital Charge Code |
5349251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.83 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$445.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,034.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.04
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.18
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$955.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$1,034.96
|
| Rate for Payer: Quartz Medicare Advantage |
$955.34
|
| Rate for Payer: The Alliance Commercial |
$796.12
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
DRILL BIT 3.0MM AR-8943-36
|
Facility
|
IP
|
$1,531.00
|
|
| Hospital Charge Code |
5349251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$955.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
DRILL BIT 3.0MM CALIBRATED LONG AR-8970-30L
|
Facility
|
IP
|
$2,596.00
|
|
| Hospital Charge Code |
5603783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,322.92 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,619.90
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
