|
DRILL BIT CANN 2.7MM AO COUPLING STRYKER 702449
|
Facility
|
OP
|
$2,212.00
|
|
| Hospital Charge Code |
5415593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.13 |
| Max. Negotiated Rate |
$2,116.44 |
| Rate for Payer: Aetna Commercial |
$2,070.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.41
|
| Rate for Payer: Aetna Managed Medicare |
$644.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,495.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,150.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.25
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$2,116.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,287.38
|
| Rate for Payer: Health EOS Commercial |
$2,047.43
|
| Rate for Payer: HFN Commercial |
$2,116.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,725.36
|
| Rate for Payer: Multiplan Commercial |
$1,840.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.24
|
| Rate for Payer: Quartz Commercial |
$1,495.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,380.29
|
| Rate for Payer: The Alliance Commercial |
$1,150.24
|
| Rate for Payer: WEA Trust Commercial |
$1,265.26
|
| Rate for Payer: WPS Commercial |
$1,703.90
|
|
|
DRILL BIT CANN 2.7MM AO COUPLING STRYKER 702449
|
Facility
|
IP
|
$2,212.00
|
|
| Hospital Charge Code |
5415593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.24 |
| Max. Negotiated Rate |
$2,116.44 |
| Rate for Payer: Aetna Commercial |
$2,070.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.25
|
| Rate for Payer: Cash Price |
$663.60
|
| Rate for Payer: Cigna Commercial |
$2,116.44
|
| Rate for Payer: Health EOS Commercial |
$2,047.43
|
| Rate for Payer: HFN Commercial |
$2,116.44
|
| Rate for Payer: Multiplan Commercial |
$1,840.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.24
|
| Rate for Payer: Quartz Commercial |
$1,380.29
|
| Rate for Payer: WEA Trust Commercial |
$1,265.26
|
| Rate for Payer: WPS Commercial |
$1,703.90
|
|
|
DRILL BIT CANN 3.0 X 170MM WITH CALIBRATIONS AO 705357
|
Facility
|
OP
|
$1,468.00
|
|
| Hospital Charge Code |
6166131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.48 |
| Max. Negotiated Rate |
$1,404.58 |
| Rate for Payer: Aetna Commercial |
$1,374.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$427.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$992.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$763.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.16
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,404.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$854.38
|
| Rate for Payer: Health EOS Commercial |
$1,358.78
|
| Rate for Payer: HFN Commercial |
$1,404.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,145.04
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$916.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.58
|
| Rate for Payer: Quartz Beloit One Network |
$748.09
|
| Rate for Payer: Quartz Commercial |
$992.37
|
| Rate for Payer: Quartz Medicare Advantage |
$916.03
|
| Rate for Payer: The Alliance Commercial |
$763.36
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,130.80
|
|
|
DRILL BIT CANN 3.0 X 170MM WITH CALIBRATIONS AO 705357
|
Facility
|
IP
|
$1,468.00
|
|
| Hospital Charge Code |
6166131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.09 |
| Max. Negotiated Rate |
$1,404.58 |
| Rate for Payer: Aetna Commercial |
$1,374.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.16
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,404.58
|
| Rate for Payer: Health EOS Commercial |
$1,358.78
|
| Rate for Payer: HFN Commercial |
$1,404.58
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.58
|
| Rate for Payer: Quartz Beloit One Network |
$748.09
|
| Rate for Payer: Quartz Commercial |
$916.03
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,130.80
|
|
|
DRILL BIT CANN 3.0 X 60MM ORTHOLOC 58850030
|
Facility
|
IP
|
$1,948.00
|
|
| Hospital Charge Code |
6173852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$992.70 |
| Max. Negotiated Rate |
$1,863.85 |
| Rate for Payer: Aetna Commercial |
$1,823.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,742.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.74
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,863.85
|
| Rate for Payer: Health EOS Commercial |
$1,803.07
|
| Rate for Payer: HFN Commercial |
$1,863.85
|
| Rate for Payer: Multiplan Commercial |
$1,620.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.85
|
| Rate for Payer: Quartz Beloit One Network |
$992.70
|
| Rate for Payer: Quartz Commercial |
$1,215.55
|
| Rate for Payer: WEA Trust Commercial |
$1,114.26
|
| Rate for Payer: WPS Commercial |
$1,500.54
|
|
|
DRILL BIT CANN 3.0 X 60MM ORTHOLOC 58850030
|
Facility
|
OP
|
$1,948.00
|
|
| Hospital Charge Code |
6173852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.26 |
| Max. Negotiated Rate |
$1,863.85 |
| Rate for Payer: Aetna Commercial |
$1,823.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,742.29
|
| Rate for Payer: Aetna Managed Medicare |
$567.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$972.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.74
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,863.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.74
|
| Rate for Payer: Health EOS Commercial |
$1,803.07
|
| Rate for Payer: HFN Commercial |
$1,863.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,519.44
|
| Rate for Payer: Multiplan Commercial |
$1,620.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,215.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.85
|
| Rate for Payer: Quartz Beloit One Network |
$992.70
|
| Rate for Payer: Quartz Commercial |
$1,316.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,215.55
|
| Rate for Payer: The Alliance Commercial |
$1,012.96
|
| Rate for Payer: WEA Trust Commercial |
$1,114.26
|
| Rate for Payer: WPS Commercial |
$1,500.54
|
|
|
DRILL BIT CANN 3.2MM 170/140MM 310.65
|
Facility
|
OP
|
$5,121.00
|
|
| Hospital Charge Code |
3375505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.24 |
| Max. Negotiated Rate |
$4,899.77 |
| Rate for Payer: Aetna Commercial |
$4,793.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,491.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,461.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,662.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,556.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.70
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,899.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,980.42
|
| Rate for Payer: Health EOS Commercial |
$4,740.00
|
| Rate for Payer: HFN Commercial |
$4,899.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,994.38
|
| Rate for Payer: Multiplan Commercial |
$4,260.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.66
|
| Rate for Payer: Quartz Commercial |
$3,461.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,195.50
|
| Rate for Payer: The Alliance Commercial |
$2,662.92
|
| Rate for Payer: WEA Trust Commercial |
$2,929.21
|
| Rate for Payer: WPS Commercial |
$3,944.71
|
|
|
DRILL BIT CANN 3.2MM 170/140MM 310.65
|
Facility
|
IP
|
$5,121.00
|
|
| Hospital Charge Code |
3375505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,609.66 |
| Max. Negotiated Rate |
$4,899.77 |
| Rate for Payer: Aetna Commercial |
$4,793.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.70
|
| Rate for Payer: Cash Price |
$1,536.30
|
| Rate for Payer: Cigna Commercial |
$4,899.77
|
| Rate for Payer: Health EOS Commercial |
$4,740.00
|
| Rate for Payer: HFN Commercial |
$4,899.77
|
| Rate for Payer: Multiplan Commercial |
$4,260.67
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.66
|
| Rate for Payer: Quartz Commercial |
$3,195.50
|
| Rate for Payer: WEA Trust Commercial |
$2,929.21
|
| Rate for Payer: WPS Commercial |
$3,944.71
|
|
|
DRILL BIT CANN 3.5MM AO FITTING 705251
|
Facility
|
IP
|
$2,666.00
|
|
| Hospital Charge Code |
6049656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,358.59 |
| Max. Negotiated Rate |
$2,550.83 |
| Rate for Payer: Aetna Commercial |
$2,495.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,469.50
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,550.83
|
| Rate for Payer: Health EOS Commercial |
$2,467.65
|
| Rate for Payer: HFN Commercial |
$2,550.83
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,550.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,358.59
|
| Rate for Payer: Quartz Commercial |
$1,663.58
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$2,053.62
|
|
|
DRILL BIT CANN 3.5MM AO FITTING 705251
|
Facility
|
OP
|
$2,666.00
|
|
| Hospital Charge Code |
6049656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.34 |
| Max. Negotiated Rate |
$2,550.83 |
| Rate for Payer: Aetna Commercial |
$2,495.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Aetna Managed Medicare |
$776.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,802.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,386.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,330.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,469.50
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,550.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,551.61
|
| Rate for Payer: Health EOS Commercial |
$2,467.65
|
| Rate for Payer: HFN Commercial |
$2,550.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,079.48
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,663.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,550.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,358.59
|
| Rate for Payer: Quartz Commercial |
$1,802.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,663.58
|
| Rate for Payer: The Alliance Commercial |
$1,386.32
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$2,053.62
|
|
|
DRILL BIT CANN 4.3MM X 200MM 310.634
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
3937334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.39 |
| Max. Negotiated Rate |
$490.84 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Aetna Managed Medicare |
$149.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$346.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$490.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.57
|
| Rate for Payer: Health EOS Commercial |
$474.83
|
| Rate for Payer: HFN Commercial |
$490.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.14
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: NAPHCARE Commercial |
$320.11
|
| Rate for Payer: Preferred Network Access Commercial |
$490.84
|
| Rate for Payer: Quartz Beloit One Network |
$261.42
|
| Rate for Payer: Quartz Commercial |
$346.79
|
| Rate for Payer: Quartz Medicare Advantage |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$266.76
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
DRILL BIT CANN 4.3MM X 200MM 310.634
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
3937334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.42 |
| Max. Negotiated Rate |
$490.84 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$490.84
|
| Rate for Payer: Health EOS Commercial |
$474.83
|
| Rate for Payer: HFN Commercial |
$490.84
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: Preferred Network Access Commercial |
$490.84
|
| Rate for Payer: Quartz Beloit One Network |
$261.42
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
DRILL BIT CANN 5.0 300MM LARGE 310.63
|
Facility
|
IP
|
$5,192.00
|
|
| Hospital Charge Code |
2966213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,645.84 |
| Max. Negotiated Rate |
$4,967.71 |
| Rate for Payer: Aetna Commercial |
$4,859.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.83
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna Commercial |
$4,967.71
|
| Rate for Payer: Health EOS Commercial |
$4,805.72
|
| Rate for Payer: HFN Commercial |
$4,967.71
|
| Rate for Payer: Multiplan Commercial |
$4,319.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.84
|
| Rate for Payer: Quartz Commercial |
$3,239.81
|
| Rate for Payer: WEA Trust Commercial |
$2,969.82
|
| Rate for Payer: WPS Commercial |
$3,999.40
|
|
|
DRILL BIT CANN 5.0 300MM LARGE 310.63
|
Facility
|
OP
|
$5,192.00
|
|
| Hospital Charge Code |
2966213
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,511.91 |
| Max. Negotiated Rate |
$4,967.71 |
| Rate for Payer: Aetna Commercial |
$4,859.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,643.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,509.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,699.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,591.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,861.83
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna Commercial |
$4,967.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,021.74
|
| Rate for Payer: Health EOS Commercial |
$4,805.72
|
| Rate for Payer: HFN Commercial |
$4,967.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,049.76
|
| Rate for Payer: Multiplan Commercial |
$4,319.74
|
| Rate for Payer: NAPHCARE Commercial |
$3,239.81
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.84
|
| Rate for Payer: Quartz Commercial |
$3,509.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,239.81
|
| Rate for Payer: The Alliance Commercial |
$2,699.84
|
| Rate for Payer: WEA Trust Commercial |
$2,969.82
|
| Rate for Payer: WPS Commercial |
$3,999.40
|
|
|
DRILL BIT CANN 5.0MM AR-8770-02
|
Facility
|
OP
|
$2,174.00
|
|
| Hospital Charge Code |
6234123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.07 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Aetna Managed Medicare |
$633.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,469.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,130.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.27
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.72
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,469.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.58
|
| Rate for Payer: The Alliance Commercial |
$1,130.48
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
|
DRILL BIT CANN 5.0MM AR-8770-02
|
Facility
|
IP
|
$2,174.00
|
|
| Hospital Charge Code |
6234123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.87 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,356.58
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
|
DRILL BIT CANN 5.0 X 200MM QUICK COUPLING 310.632
|
Facility
|
IP
|
$2,715.00
|
|
| Hospital Charge Code |
4289891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.56 |
| Max. Negotiated Rate |
$2,597.71 |
| Rate for Payer: Aetna Commercial |
$2,541.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,428.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.51
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,597.71
|
| Rate for Payer: Health EOS Commercial |
$2,513.00
|
| Rate for Payer: HFN Commercial |
$2,597.71
|
| Rate for Payer: Multiplan Commercial |
$2,258.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.56
|
| Rate for Payer: Quartz Commercial |
$1,694.16
|
| Rate for Payer: WEA Trust Commercial |
$1,552.98
|
| Rate for Payer: WPS Commercial |
$2,091.36
|
|
|
DRILL BIT CANN 5.0 X 200MM QUICK COUPLING 310.632
|
Facility
|
OP
|
$2,715.00
|
|
| Hospital Charge Code |
4289891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.61 |
| Max. Negotiated Rate |
$2,597.71 |
| Rate for Payer: Aetna Commercial |
$2,541.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,428.30
|
| Rate for Payer: Aetna Managed Medicare |
$790.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,835.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.51
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,597.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,580.13
|
| Rate for Payer: Health EOS Commercial |
$2,513.00
|
| Rate for Payer: HFN Commercial |
$2,597.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.70
|
| Rate for Payer: Multiplan Commercial |
$2,258.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,694.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.56
|
| Rate for Payer: Quartz Commercial |
$1,835.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,694.16
|
| Rate for Payer: The Alliance Commercial |
$1,411.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.98
|
| Rate for Payer: WPS Commercial |
$2,091.36
|
|
|
DRILL BIT CANN 5.0 X 215MM LARGE QUICK COUPLING 03.333.104
|
Facility
|
OP
|
$4,396.86
|
|
| Hospital Charge Code |
6248159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,280.37 |
| Max. Negotiated Rate |
$4,206.92 |
| Rate for Payer: Aetna Commercial |
$4,115.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,932.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,280.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,972.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,286.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,194.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,423.55
|
| Rate for Payer: Cash Price |
$1,319.06
|
| Rate for Payer: Cigna Commercial |
$4,206.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,558.97
|
| Rate for Payer: Health EOS Commercial |
$4,069.73
|
| Rate for Payer: HFN Commercial |
$4,206.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,429.55
|
| Rate for Payer: Multiplan Commercial |
$3,658.19
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.64
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.64
|
| Rate for Payer: Quartz Commercial |
$2,972.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,743.64
|
| Rate for Payer: The Alliance Commercial |
$2,286.37
|
| Rate for Payer: WEA Trust Commercial |
$2,515.00
|
| Rate for Payer: WPS Commercial |
$3,386.90
|
|
|
DRILL BIT CANN 5.0 X 215MM LARGE QUICK COUPLING 03.333.104
|
Facility
|
IP
|
$4,396.86
|
|
| Hospital Charge Code |
6248159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,240.64 |
| Max. Negotiated Rate |
$4,206.92 |
| Rate for Payer: Aetna Commercial |
$4,115.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,932.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,423.55
|
| Rate for Payer: Cash Price |
$1,319.06
|
| Rate for Payer: Cigna Commercial |
$4,206.92
|
| Rate for Payer: Health EOS Commercial |
$4,069.73
|
| Rate for Payer: HFN Commercial |
$4,206.92
|
| Rate for Payer: Multiplan Commercial |
$3,658.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.64
|
| Rate for Payer: Quartz Commercial |
$2,743.64
|
| Rate for Payer: WEA Trust Commercial |
$2,515.00
|
| Rate for Payer: WPS Commercial |
$3,386.90
|
|
|
DRILL BIT CANN AND COUNTERSINK 1.7MM X L12MM XFO051201
|
Facility
|
OP
|
$2,627.00
|
|
| Hospital Charge Code |
5583413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$764.98 |
| Max. Negotiated Rate |
$2,513.51 |
| Rate for Payer: Aetna Commercial |
$2,458.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,349.59
|
| Rate for Payer: Aetna Managed Medicare |
$764.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,775.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,366.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,311.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,448.00
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$2,513.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,528.91
|
| Rate for Payer: Health EOS Commercial |
$2,431.55
|
| Rate for Payer: HFN Commercial |
$2,513.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,049.06
|
| Rate for Payer: Multiplan Commercial |
$2,185.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,639.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,513.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,338.72
|
| Rate for Payer: Quartz Commercial |
$1,775.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,639.25
|
| Rate for Payer: The Alliance Commercial |
$1,366.04
|
| Rate for Payer: WEA Trust Commercial |
$1,502.64
|
| Rate for Payer: WPS Commercial |
$2,023.58
|
|
|
DRILL BIT CANN AND COUNTERSINK 1.7MM X L12MM XFO051201
|
Facility
|
IP
|
$2,627.00
|
|
| Hospital Charge Code |
5583413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.72 |
| Max. Negotiated Rate |
$2,513.51 |
| Rate for Payer: Aetna Commercial |
$2,458.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,349.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,448.00
|
| Rate for Payer: Cash Price |
$788.10
|
| Rate for Payer: Cigna Commercial |
$2,513.51
|
| Rate for Payer: Health EOS Commercial |
$2,431.55
|
| Rate for Payer: HFN Commercial |
$2,513.51
|
| Rate for Payer: Multiplan Commercial |
$2,185.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,513.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,338.72
|
| Rate for Payer: Quartz Commercial |
$1,639.25
|
| Rate for Payer: WEA Trust Commercial |
$1,502.64
|
| Rate for Payer: WPS Commercial |
$2,023.58
|
|
|
DRILL BIT CANN AND COUNTERSINK 2.0MM X L12MM XFO041201
|
Facility
|
OP
|
$2,318.00
|
|
| Hospital Charge Code |
5583414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Aetna Managed Medicare |
$675.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,566.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,205.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.08
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,808.04
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,446.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,566.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,446.43
|
| Rate for Payer: The Alliance Commercial |
$1,205.36
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
DRILL BIT CANN AND COUNTERSINK 2.0MM X L12MM XFO041201
|
Facility
|
IP
|
$2,318.00
|
|
| Hospital Charge Code |
5583414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,446.43
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
DRILL BIT CANNULATED 2.0MM AR-8610DB-30C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5384921
|
|
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
|
|
