|
DRILL BIT BIO-SUTURE TAK AR-1250LT
|
Facility
|
OP
|
$1,647.00
|
|
| Hospital Charge Code |
2964713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
DRILL BIT CANN 10.2MM X 251MM 03.168.005
|
Facility
|
IP
|
$3,336.00
|
|
| Hospital Charge Code |
6178978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,700.03 |
| Max. Negotiated Rate |
$3,191.88 |
| Rate for Payer: Aetna Commercial |
$3,122.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,983.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,838.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,191.88
|
| Rate for Payer: Health EOS Commercial |
$3,087.80
|
| Rate for Payer: HFN Commercial |
$3,191.88
|
| Rate for Payer: Multiplan Commercial |
$2,775.55
|
| Rate for Payer: Preferred Network Access Commercial |
$3,191.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,700.03
|
| Rate for Payer: Quartz Commercial |
$2,081.66
|
| Rate for Payer: WEA Trust Commercial |
$1,908.19
|
| Rate for Payer: WPS Commercial |
$2,569.72
|
|
|
DRILL BIT CANN 10.2MM X 251MM 03.168.005
|
Facility
|
OP
|
$3,336.00
|
|
| Hospital Charge Code |
6178978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.44 |
| Max. Negotiated Rate |
$3,191.88 |
| Rate for Payer: Aetna Commercial |
$3,122.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,983.72
|
| Rate for Payer: Aetna Managed Medicare |
$971.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,255.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,734.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,665.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,838.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$3,191.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,941.55
|
| Rate for Payer: Health EOS Commercial |
$3,087.80
|
| Rate for Payer: HFN Commercial |
$3,191.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,602.08
|
| Rate for Payer: Multiplan Commercial |
$2,775.55
|
| Rate for Payer: NAPHCARE Commercial |
$2,081.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,191.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,700.03
|
| Rate for Payer: Quartz Commercial |
$2,255.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,081.66
|
| Rate for Payer: The Alliance Commercial |
$1,734.72
|
| Rate for Payer: WEA Trust Commercial |
$1,908.19
|
| Rate for Payer: WPS Commercial |
$2,569.72
|
|
|
DRILL BIT CANN 14MM FLEXIBLE 03.033.004
|
Facility
|
OP
|
$6,143.00
|
|
| Hospital Charge Code |
6182648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,788.84 |
| Max. Negotiated Rate |
$5,877.62 |
| Rate for Payer: Aetna Commercial |
$5,749.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,494.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,788.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,152.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,194.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,066.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,386.02
|
| Rate for Payer: Cash Price |
$1,842.90
|
| Rate for Payer: Cigna Commercial |
$5,877.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,575.23
|
| Rate for Payer: Health EOS Commercial |
$5,685.96
|
| Rate for Payer: HFN Commercial |
$5,877.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,791.54
|
| Rate for Payer: Multiplan Commercial |
$5,110.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,833.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,877.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,130.47
|
| Rate for Payer: Quartz Commercial |
$4,152.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3,833.23
|
| Rate for Payer: The Alliance Commercial |
$3,194.36
|
| Rate for Payer: WEA Trust Commercial |
$3,513.80
|
| Rate for Payer: WPS Commercial |
$4,731.95
|
|
|
DRILL BIT CANN 14MM FLEXIBLE 03.033.004
|
Facility
|
IP
|
$6,143.00
|
|
| Hospital Charge Code |
6182648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,130.47 |
| Max. Negotiated Rate |
$5,877.62 |
| Rate for Payer: Aetna Commercial |
$5,749.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,494.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,386.02
|
| Rate for Payer: Cash Price |
$1,842.90
|
| Rate for Payer: Cigna Commercial |
$5,877.62
|
| Rate for Payer: Health EOS Commercial |
$5,685.96
|
| Rate for Payer: HFN Commercial |
$5,877.62
|
| Rate for Payer: Multiplan Commercial |
$5,110.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,877.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,130.47
|
| Rate for Payer: Quartz Commercial |
$3,833.23
|
| Rate for Payer: WEA Trust Commercial |
$3,513.80
|
| Rate for Payer: WPS Commercial |
$4,731.95
|
|
|
DRILL BIT CANN 1.7MM AO 45-20005S
|
Facility
|
IP
|
$1,346.00
|
|
| Hospital Charge Code |
5767633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.92 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$839.90
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
DRILL BIT CANN 1.7MM AO 45-20005S
|
Facility
|
OP
|
$1,346.00
|
|
| Hospital Charge Code |
5767633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.96 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Aetna Managed Medicare |
$391.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.37
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.88
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: NAPHCARE Commercial |
$839.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$909.90
|
| Rate for Payer: Quartz Medicare Advantage |
$839.90
|
| Rate for Payer: The Alliance Commercial |
$699.92
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
DRILL BIT CANN 1.7MM AR-8737-17
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5415097
|
|
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 CANN 1.7MM AR-8737-17
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5415097
|
|
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 CANN 1.7MM LONG QR 316-0514
|
Facility
|
OP
|
$3,530.00
|
|
| Hospital Charge Code |
5809999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,027.94 |
| Max. Negotiated Rate |
$3,377.50 |
| Rate for Payer: Aetna Commercial |
$3,304.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,157.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,027.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,386.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,835.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,762.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,945.74
|
| Rate for Payer: Cash Price |
$1,059.00
|
| Rate for Payer: Cigna Commercial |
$3,377.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,054.46
|
| Rate for Payer: Health EOS Commercial |
$3,267.37
|
| Rate for Payer: HFN Commercial |
$3,377.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,753.40
|
| Rate for Payer: Multiplan Commercial |
$2,936.96
|
| Rate for Payer: NAPHCARE Commercial |
$2,202.72
|
| Rate for Payer: Preferred Network Access Commercial |
$3,377.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,798.89
|
| Rate for Payer: Quartz Commercial |
$2,386.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,202.72
|
| Rate for Payer: The Alliance Commercial |
$1,835.60
|
| Rate for Payer: WEA Trust Commercial |
$2,019.16
|
| Rate for Payer: WPS Commercial |
$2,719.16
|
|
|
DRILL BIT CANN 1.7MM LONG QR 316-0514
|
Facility
|
IP
|
$3,530.00
|
|
| Hospital Charge Code |
5809999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,798.89 |
| Max. Negotiated Rate |
$3,377.50 |
| Rate for Payer: Aetna Commercial |
$3,304.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,157.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,945.74
|
| Rate for Payer: Cash Price |
$1,059.00
|
| Rate for Payer: Cigna Commercial |
$3,377.50
|
| Rate for Payer: Health EOS Commercial |
$3,267.37
|
| Rate for Payer: HFN Commercial |
$3,377.50
|
| Rate for Payer: Multiplan Commercial |
$2,936.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,377.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,798.89
|
| Rate for Payer: Quartz Commercial |
$2,202.72
|
| Rate for Payer: WEA Trust Commercial |
$2,019.16
|
| Rate for Payer: WPS Commercial |
$2,719.16
|
|
|
DRILL BIT CANN 1.7 X 1.32MM XFO073200
|
Facility
|
OP
|
$2,642.00
|
|
| Hospital Charge Code |
5286739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.35 |
| Max. Negotiated Rate |
$2,527.87 |
| Rate for Payer: Aetna Commercial |
$2,472.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,363.00
|
| Rate for Payer: Aetna Managed Medicare |
$769.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,456.27
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cigna Commercial |
$2,527.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.64
|
| Rate for Payer: Health EOS Commercial |
$2,445.44
|
| Rate for Payer: HFN Commercial |
$2,527.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.76
|
| Rate for Payer: Multiplan Commercial |
$2,198.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.36
|
| Rate for Payer: Quartz Commercial |
$1,785.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.61
|
| Rate for Payer: The Alliance Commercial |
$1,373.84
|
| Rate for Payer: WEA Trust Commercial |
$1,511.22
|
| Rate for Payer: WPS Commercial |
$2,035.13
|
|
|
DRILL BIT CANN 1.7 X 1.32MM XFO073200
|
Facility
|
IP
|
$2,642.00
|
|
| Hospital Charge Code |
5286739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,346.36 |
| Max. Negotiated Rate |
$2,527.87 |
| Rate for Payer: Aetna Commercial |
$2,472.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,363.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,456.27
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cigna Commercial |
$2,527.87
|
| Rate for Payer: Health EOS Commercial |
$2,445.44
|
| Rate for Payer: HFN Commercial |
$2,527.87
|
| Rate for Payer: Multiplan Commercial |
$2,198.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.36
|
| Rate for Payer: Quartz Commercial |
$1,648.61
|
| Rate for Payer: WEA Trust Commercial |
$1,511.22
|
| Rate for Payer: WPS Commercial |
$2,035.13
|
|
|
DRILL BIT CANN 1.9MM (YELLOW) IS1112
|
Facility
|
IP
|
$2,756.00
|
|
| Hospital Charge Code |
5685826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,404.46 |
| Max. Negotiated Rate |
$2,636.94 |
| Rate for Payer: Aetna Commercial |
$2,579.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,464.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,519.11
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,636.94
|
| Rate for Payer: Health EOS Commercial |
$2,550.95
|
| Rate for Payer: HFN Commercial |
$2,636.94
|
| Rate for Payer: Multiplan Commercial |
$2,292.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,636.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,404.46
|
| Rate for Payer: Quartz Commercial |
$1,719.74
|
| Rate for Payer: WEA Trust Commercial |
$1,576.43
|
| Rate for Payer: WPS Commercial |
$2,122.95
|
|
|
DRILL BIT CANN 1.9MM (YELLOW) IS1112
|
Facility
|
OP
|
$2,756.00
|
|
| Hospital Charge Code |
5685826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.55 |
| Max. Negotiated Rate |
$2,636.94 |
| Rate for Payer: Aetna Commercial |
$2,579.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,464.97
|
| Rate for Payer: Aetna Managed Medicare |
$802.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,863.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,433.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,375.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,519.11
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,636.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,603.99
|
| Rate for Payer: Health EOS Commercial |
$2,550.95
|
| Rate for Payer: HFN Commercial |
$2,636.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,149.68
|
| Rate for Payer: Multiplan Commercial |
$2,292.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,719.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,636.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,404.46
|
| Rate for Payer: Quartz Commercial |
$1,863.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,719.74
|
| Rate for Payer: The Alliance Commercial |
$1,433.12
|
| Rate for Payer: WEA Trust Commercial |
$1,576.43
|
| Rate for Payer: WPS Commercial |
$2,122.95
|
|
|
DRILL BIT CANN 2.0/2.4 TIGER 210-24-001
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3491511
|
|
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 CANN 2.0/2.4 TIGER 210-24-001
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3491511
|
|
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 CANN 2.0 X 145MM QUICK COUPLING 03.333.101
|
Facility
|
OP
|
$2,147.87
|
|
| Hospital Charge Code |
6248163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.46 |
| Max. Negotiated Rate |
$2,055.08 |
| Rate for Payer: Aetna Commercial |
$2,010.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.05
|
| Rate for Payer: Aetna Managed Medicare |
$625.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,451.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,072.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,183.91
|
| Rate for Payer: Cash Price |
$644.36
|
| Rate for Payer: Cigna Commercial |
$2,055.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,250.06
|
| Rate for Payer: Health EOS Commercial |
$1,988.07
|
| Rate for Payer: HFN Commercial |
$2,055.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,675.34
|
| Rate for Payer: Multiplan Commercial |
$1,787.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.55
|
| Rate for Payer: Quartz Commercial |
$1,451.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,340.27
|
| Rate for Payer: The Alliance Commercial |
$1,116.89
|
| Rate for Payer: WEA Trust Commercial |
$1,228.58
|
| Rate for Payer: WPS Commercial |
$1,654.50
|
|
|
DRILL BIT CANN 2.0 X 145MM QUICK COUPLING 03.333.101
|
Facility
|
IP
|
$2,147.87
|
|
| Hospital Charge Code |
6248163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,094.55 |
| Max. Negotiated Rate |
$2,055.08 |
| Rate for Payer: Aetna Commercial |
$2,010.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,183.91
|
| Rate for Payer: Cash Price |
$644.36
|
| Rate for Payer: Cigna Commercial |
$2,055.08
|
| Rate for Payer: Health EOS Commercial |
$1,988.07
|
| Rate for Payer: HFN Commercial |
$2,055.08
|
| Rate for Payer: Multiplan Commercial |
$1,787.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.55
|
| Rate for Payer: Quartz Commercial |
$1,340.27
|
| Rate for Payer: WEA Trust Commercial |
$1,228.58
|
| Rate for Payer: WPS Commercial |
$1,654.50
|
|
|
DRILL BIT CANN 2.1MM (GREEN) IS1113
|
Facility
|
IP
|
$2,756.00
|
|
| Hospital Charge Code |
5659624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,404.46 |
| Max. Negotiated Rate |
$2,636.94 |
| Rate for Payer: Aetna Commercial |
$2,579.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,464.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,519.11
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,636.94
|
| Rate for Payer: Health EOS Commercial |
$2,550.95
|
| Rate for Payer: HFN Commercial |
$2,636.94
|
| Rate for Payer: Multiplan Commercial |
$2,292.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,636.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,404.46
|
| Rate for Payer: Quartz Commercial |
$1,719.74
|
| Rate for Payer: WEA Trust Commercial |
$1,576.43
|
| Rate for Payer: WPS Commercial |
$2,122.95
|
|
|
DRILL BIT CANN 2.1MM (GREEN) IS1113
|
Facility
|
OP
|
$2,756.00
|
|
| Hospital Charge Code |
5659624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.55 |
| Max. Negotiated Rate |
$2,636.94 |
| Rate for Payer: Aetna Commercial |
$2,579.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,464.97
|
| Rate for Payer: Aetna Managed Medicare |
$802.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,863.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,433.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,375.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,519.11
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$2,636.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,603.99
|
| Rate for Payer: Health EOS Commercial |
$2,550.95
|
| Rate for Payer: HFN Commercial |
$2,636.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,149.68
|
| Rate for Payer: Multiplan Commercial |
$2,292.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,719.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,636.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,404.46
|
| Rate for Payer: Quartz Commercial |
$1,863.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,719.74
|
| Rate for Payer: The Alliance Commercial |
$1,433.12
|
| Rate for Payer: WEA Trust Commercial |
$1,576.43
|
| Rate for Payer: WPS Commercial |
$2,122.95
|
|
|
DRILL BIT CANN 2.4MM & PASSING WIRE AR-1594D-24
|
Facility
|
OP
|
$2,929.00
|
|
| Hospital Charge Code |
6220125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Aetna Managed Medicare |
$852.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.68
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.62
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,980.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,827.70
|
| Rate for Payer: The Alliance Commercial |
$1,523.08
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
DRILL BIT CANN 2.4MM & PASSING WIRE AR-1594D-24
|
Facility
|
IP
|
$2,929.00
|
|
| Hospital Charge Code |
6220125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,492.62 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,827.70
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
DRILL BIT CANN 2.6MM IS1114
|
Facility
|
IP
|
$1,986.00
|
|
| Hospital Charge Code |
6171785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,012.07 |
| Max. Negotiated Rate |
$1,900.20 |
| Rate for Payer: Aetna Commercial |
$1,858.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,776.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.68
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,900.20
|
| Rate for Payer: Health EOS Commercial |
$1,838.24
|
| Rate for Payer: HFN Commercial |
$1,900.20
|
| Rate for Payer: Multiplan Commercial |
$1,652.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,012.07
|
| Rate for Payer: Quartz Commercial |
$1,239.26
|
| Rate for Payer: WEA Trust Commercial |
$1,135.99
|
| Rate for Payer: WPS Commercial |
$1,529.82
|
|
|
DRILL BIT CANN 2.6MM IS1114
|
Facility
|
OP
|
$1,986.00
|
|
| Hospital Charge Code |
6171785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.32 |
| Max. Negotiated Rate |
$1,900.20 |
| Rate for Payer: Aetna Commercial |
$1,858.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,776.28
|
| Rate for Payer: Aetna Managed Medicare |
$578.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,342.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,032.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$991.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.68
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,900.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,155.85
|
| Rate for Payer: Health EOS Commercial |
$1,838.24
|
| Rate for Payer: HFN Commercial |
$1,900.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,549.08
|
| Rate for Payer: Multiplan Commercial |
$1,652.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,239.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,012.07
|
| Rate for Payer: Quartz Commercial |
$1,342.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,239.26
|
| Rate for Payer: The Alliance Commercial |
$1,032.72
|
| Rate for Payer: WEA Trust Commercial |
$1,135.99
|
| Rate for Payer: WPS Commercial |
$1,529.82
|
|
