|
DRILL BIT 3.5 X 230MM AO 1806-3540S
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
6204988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.31 |
| Max. Negotiated Rate |
$1,325.17 |
| Rate for Payer: Aetna Commercial |
$1,296.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.74
|
| Rate for Payer: Aetna Managed Medicare |
$403.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$936.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$720.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.41
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,325.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$806.07
|
| Rate for Payer: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,080.30
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: NAPHCARE Commercial |
$864.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$936.26
|
| Rate for Payer: Quartz Medicare Advantage |
$864.24
|
| Rate for Payer: The Alliance Commercial |
$720.20
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
|
DRILL BIT 3.5 X 60MM ORTHOLOC 58850035
|
Facility
|
IP
|
$2,251.00
|
|
| Hospital Charge Code |
5729841
|
|
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 3.5 X 60MM ORTHOLOC 58850035
|
Facility
|
OP
|
$2,251.00
|
|
| Hospital Charge Code |
5729841
|
|
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 3.8MM ORTHOLOC 59250038
|
Facility
|
IP
|
$1,948.00
|
|
| Hospital Charge Code |
6201065
|
|
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 3.8MM ORTHOLOC 59250038
|
Facility
|
OP
|
$1,948.00
|
|
| Hospital Charge Code |
6201065
|
|
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 3.8 THREE-FLUTED 03.019.016
|
Facility
|
OP
|
$2,791.00
|
|
| Hospital Charge Code |
3000351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.74 |
| Max. Negotiated Rate |
$2,670.43 |
| Rate for Payer: Aetna Commercial |
$2,612.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,496.27
|
| Rate for Payer: Aetna Managed Medicare |
$812.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,393.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.40
|
| Rate for Payer: Cash Price |
$837.30
|
| Rate for Payer: Cigna Commercial |
$2,670.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,624.36
|
| Rate for Payer: Health EOS Commercial |
$2,583.35
|
| Rate for Payer: HFN Commercial |
$2,670.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.98
|
| Rate for Payer: Multiplan Commercial |
$2,322.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,670.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.29
|
| Rate for Payer: Quartz Commercial |
$1,886.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.58
|
| Rate for Payer: The Alliance Commercial |
$1,451.32
|
| Rate for Payer: WEA Trust Commercial |
$1,596.45
|
| Rate for Payer: WPS Commercial |
$2,149.91
|
|
|
DRILL BIT 3.8 THREE-FLUTED 03.019.016
|
Facility
|
IP
|
$2,791.00
|
|
| Hospital Charge Code |
3000351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,422.29 |
| Max. Negotiated Rate |
$2,670.43 |
| Rate for Payer: Aetna Commercial |
$2,612.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,496.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.40
|
| Rate for Payer: Cash Price |
$837.30
|
| Rate for Payer: Cigna Commercial |
$2,670.43
|
| Rate for Payer: Health EOS Commercial |
$2,583.35
|
| Rate for Payer: HFN Commercial |
$2,670.43
|
| Rate for Payer: Multiplan Commercial |
$2,322.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,670.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.29
|
| Rate for Payer: Quartz Commercial |
$1,741.58
|
| Rate for Payer: WEA Trust Commercial |
$1,596.45
|
| Rate for Payer: WPS Commercial |
$2,149.91
|
|
|
DRILL BIT 3.9/6.0
|
Facility
|
OP
|
$6,062.00
|
|
| Hospital Charge Code |
2966201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,765.25 |
| Max. Negotiated Rate |
$5,800.12 |
| Rate for Payer: Aetna Commercial |
$5,674.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,421.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,097.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,152.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,341.37
|
| Rate for Payer: Cash Price |
$1,818.60
|
| Rate for Payer: Cigna Commercial |
$5,800.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.08
|
| Rate for Payer: Health EOS Commercial |
$5,610.99
|
| Rate for Payer: HFN Commercial |
$5,800.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,728.36
|
| Rate for Payer: Multiplan Commercial |
$5,043.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,782.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,800.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.20
|
| Rate for Payer: Quartz Commercial |
$4,097.91
|
| Rate for Payer: Quartz Medicare Advantage |
$3,782.69
|
| Rate for Payer: The Alliance Commercial |
$3,152.24
|
| Rate for Payer: WEA Trust Commercial |
$3,467.46
|
| Rate for Payer: WPS Commercial |
$4,669.56
|
|
|
DRILL BIT 3.9/6.0
|
Facility
|
IP
|
$6,062.00
|
|
| Hospital Charge Code |
2966201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,089.20 |
| Max. Negotiated Rate |
$5,800.12 |
| Rate for Payer: Aetna Commercial |
$5,674.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,421.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,341.37
|
| Rate for Payer: Cash Price |
$1,818.60
|
| Rate for Payer: Cigna Commercial |
$5,800.12
|
| Rate for Payer: Health EOS Commercial |
$5,610.99
|
| Rate for Payer: HFN Commercial |
$5,800.12
|
| Rate for Payer: Multiplan Commercial |
$5,043.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,800.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.20
|
| Rate for Payer: Quartz Commercial |
$3,782.69
|
| Rate for Payer: WEA Trust Commercial |
$3,467.46
|
| Rate for Payer: WPS Commercial |
$4,669.56
|
|
|
DRILL BIT 3-FLUTED
|
Facility
|
IP
|
$2,959.00
|
|
| Hospital Charge Code |
2966202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,507.91 |
| Max. Negotiated Rate |
$2,831.17 |
| Rate for Payer: Aetna Commercial |
$2,769.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,646.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,631.00
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna Commercial |
$2,831.17
|
| Rate for Payer: Health EOS Commercial |
$2,738.85
|
| Rate for Payer: HFN Commercial |
$2,831.17
|
| Rate for Payer: Multiplan Commercial |
$2,461.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,831.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.91
|
| Rate for Payer: Quartz Commercial |
$1,846.42
|
| Rate for Payer: WEA Trust Commercial |
$1,692.55
|
| Rate for Payer: WPS Commercial |
$2,279.32
|
|
|
DRILL BIT 3-FLUTED
|
Facility
|
OP
|
$2,959.00
|
|
| Hospital Charge Code |
2966202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$861.66 |
| Max. Negotiated Rate |
$2,831.17 |
| Rate for Payer: Aetna Commercial |
$2,769.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,646.53
|
| Rate for Payer: Aetna Managed Medicare |
$861.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,000.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,538.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,477.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,631.00
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna Commercial |
$2,831.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,722.14
|
| Rate for Payer: Health EOS Commercial |
$2,738.85
|
| Rate for Payer: HFN Commercial |
$2,831.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,308.02
|
| Rate for Payer: Multiplan Commercial |
$2,461.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,846.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,831.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.91
|
| Rate for Payer: Quartz Commercial |
$2,000.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,846.42
|
| Rate for Payer: The Alliance Commercial |
$1,538.68
|
| Rate for Payer: WEA Trust Commercial |
$1,692.55
|
| Rate for Payer: WPS Commercial |
$2,279.32
|
|
|
DRILL BIT 3-FLUTED 3.9/4.2
|
Facility
|
IP
|
$2,445.00
|
|
| Hospital Charge Code |
2966203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,245.97 |
| Max. Negotiated Rate |
$2,339.38 |
| Rate for Payer: Aetna Commercial |
$2,288.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,186.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,347.68
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$2,339.38
|
| Rate for Payer: Health EOS Commercial |
$2,263.09
|
| Rate for Payer: HFN Commercial |
$2,339.38
|
| Rate for Payer: Multiplan Commercial |
$2,034.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,339.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,245.97
|
| Rate for Payer: Quartz Commercial |
$1,525.68
|
| Rate for Payer: WEA Trust Commercial |
$1,398.54
|
| Rate for Payer: WPS Commercial |
$1,883.38
|
|
|
DRILL BIT 3-FLUTED 3.9/4.2
|
Facility
|
OP
|
$2,445.00
|
|
| Hospital Charge Code |
2966203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$711.98 |
| Max. Negotiated Rate |
$2,339.38 |
| Rate for Payer: Aetna Commercial |
$2,288.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,186.81
|
| Rate for Payer: Aetna Managed Medicare |
$711.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,652.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,220.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,347.68
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$2,339.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,422.99
|
| Rate for Payer: Health EOS Commercial |
$2,263.09
|
| Rate for Payer: HFN Commercial |
$2,339.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,907.10
|
| Rate for Payer: Multiplan Commercial |
$2,034.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,525.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,339.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,245.97
|
| Rate for Payer: Quartz Commercial |
$1,652.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,525.68
|
| Rate for Payer: The Alliance Commercial |
$1,271.40
|
| Rate for Payer: WEA Trust Commercial |
$1,398.54
|
| Rate for Payer: WPS Commercial |
$1,883.38
|
|
|
DRILL BIT 3-FLUTED 4.0x260 357.407
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2969384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$859.91 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Aetna Managed Medicare |
$859.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.65
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.34
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,996.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.67
|
| Rate for Payer: The Alliance Commercial |
$1,535.56
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
DRILL BIT 3-FLUTED 4.0x260 357.407
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2969384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,504.85 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,842.67
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
DRILL BIT 3MM CANN AR-8933-30C
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5459540
|
|
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 3MM CANN AR-8933-30C
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5459540
|
|
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 4.0MM 3-FLUTED 315.40
|
Facility
|
IP
|
$2,244.00
|
|
| Hospital Charge Code |
2966205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,143.54 |
| Max. Negotiated Rate |
$2,147.06 |
| Rate for Payer: Aetna Commercial |
$2,100.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,007.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,236.89
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$2,147.06
|
| Rate for Payer: Health EOS Commercial |
$2,077.05
|
| Rate for Payer: HFN Commercial |
$2,147.06
|
| Rate for Payer: Multiplan Commercial |
$1,867.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,147.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.54
|
| Rate for Payer: Quartz Commercial |
$1,400.26
|
| Rate for Payer: WEA Trust Commercial |
$1,283.57
|
| Rate for Payer: WPS Commercial |
$1,728.55
|
|
|
DRILL BIT 4.0MM 3-FLUTED 315.40
|
Facility
|
OP
|
$2,244.00
|
|
| Hospital Charge Code |
2966205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.45 |
| Max. Negotiated Rate |
$2,147.06 |
| Rate for Payer: Aetna Commercial |
$2,100.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,007.03
|
| Rate for Payer: Aetna Managed Medicare |
$653.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,516.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,120.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,236.89
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$2,147.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,306.01
|
| Rate for Payer: Health EOS Commercial |
$2,077.05
|
| Rate for Payer: HFN Commercial |
$2,147.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,750.32
|
| Rate for Payer: Multiplan Commercial |
$1,867.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,400.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,147.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.54
|
| Rate for Payer: Quartz Commercial |
$1,516.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,400.26
|
| Rate for Payer: The Alliance Commercial |
$1,166.88
|
| Rate for Payer: WEA Trust Commercial |
$1,283.57
|
| Rate for Payer: WPS Commercial |
$1,728.55
|
|
|
DRILL BIT 4.0MM AR-4160-40
|
Facility
|
OP
|
$1,600.00
|
|
| Hospital Charge Code |
5591336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$465.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.20
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$998.40
|
| Rate for Payer: The Alliance Commercial |
$832.00
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
DRILL BIT 4.0MM AR-4160-40
|
Facility
|
IP
|
$1,600.00
|
|
| Hospital Charge Code |
5591336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.48
|
|
|
DRILL BIT 4.0MM X 200MM 5085-2-040
|
Facility
|
IP
|
$1,909.00
|
|
| Hospital Charge Code |
5685713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$972.83 |
| Max. Negotiated Rate |
$1,826.53 |
| Rate for Payer: Aetna Commercial |
$1,786.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.24
|
| Rate for Payer: Cash Price |
$572.70
|
| Rate for Payer: Cigna Commercial |
$1,826.53
|
| Rate for Payer: Health EOS Commercial |
$1,766.97
|
| Rate for Payer: HFN Commercial |
$1,826.53
|
| Rate for Payer: Multiplan Commercial |
$1,588.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,826.53
|
| Rate for Payer: Quartz Beloit One Network |
$972.83
|
| Rate for Payer: Quartz Commercial |
$1,191.22
|
| Rate for Payer: WEA Trust Commercial |
$1,091.95
|
| Rate for Payer: WPS Commercial |
$1,470.50
|
|
|
DRILL BIT 4.0MM X 200MM 5085-2-040
|
Facility
|
OP
|
$1,909.00
|
|
| Hospital Charge Code |
5685713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.90 |
| Max. Negotiated Rate |
$1,826.53 |
| Rate for Payer: Aetna Commercial |
$1,786.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.41
|
| Rate for Payer: Aetna Managed Medicare |
$555.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,290.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$992.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$952.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.24
|
| Rate for Payer: Cash Price |
$572.70
|
| Rate for Payer: Cigna Commercial |
$1,826.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.04
|
| Rate for Payer: Health EOS Commercial |
$1,766.97
|
| Rate for Payer: HFN Commercial |
$1,826.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,489.02
|
| Rate for Payer: Multiplan Commercial |
$1,588.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,826.53
|
| Rate for Payer: Quartz Beloit One Network |
$972.83
|
| Rate for Payer: Quartz Commercial |
$1,290.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,191.22
|
| Rate for Payer: The Alliance Commercial |
$992.68
|
| Rate for Payer: WEA Trust Commercial |
$1,091.95
|
| Rate for Payer: WPS Commercial |
$1,470.50
|
|
|
DRILL BIT 4.0 X 60MM ORTHOLOC 58850040
|
Facility
|
OP
|
$1,954.00
|
|
| Hospital Charge Code |
6206992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.00 |
| Max. Negotiated Rate |
$1,869.59 |
| Rate for Payer: Aetna Commercial |
$1,828.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,747.66
|
| Rate for Payer: Aetna Managed Medicare |
$569.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.04
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$1,869.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.23
|
| Rate for Payer: Health EOS Commercial |
$1,808.62
|
| Rate for Payer: HFN Commercial |
$1,869.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.12
|
| Rate for Payer: Multiplan Commercial |
$1,625.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.59
|
| Rate for Payer: Quartz Beloit One Network |
$995.76
|
| Rate for Payer: Quartz Commercial |
$1,320.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.30
|
| Rate for Payer: The Alliance Commercial |
$1,016.08
|
| Rate for Payer: WEA Trust Commercial |
$1,117.69
|
| Rate for Payer: WPS Commercial |
$1,505.17
|
|
|
DRILL BIT 4.0 X 60MM ORTHOLOC 58850040
|
Facility
|
IP
|
$1,954.00
|
|
| Hospital Charge Code |
6206992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.76 |
| Max. Negotiated Rate |
$1,869.59 |
| Rate for Payer: Aetna Commercial |
$1,828.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,747.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.04
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$1,869.59
|
| Rate for Payer: Health EOS Commercial |
$1,808.62
|
| Rate for Payer: HFN Commercial |
$1,869.59
|
| Rate for Payer: Multiplan Commercial |
$1,625.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.59
|
| Rate for Payer: Quartz Beloit One Network |
$995.76
|
| Rate for Payer: Quartz Commercial |
$1,219.30
|
| Rate for Payer: WEA Trust Commercial |
$1,117.69
|
| Rate for Payer: WPS Commercial |
$1,505.17
|
|
