|
DRILL BIT 6.5 CONICAL W STOP
|
Facility
|
OP
|
$4,188.00
|
|
| Hospital Charge Code |
2966215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,219.55 |
| Max. Negotiated Rate |
$4,007.08 |
| Rate for Payer: Aetna Commercial |
$3,919.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,745.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,831.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,177.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,090.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,308.43
|
| Rate for Payer: Cash Price |
$1,256.40
|
| Rate for Payer: Cigna Commercial |
$4,007.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,437.42
|
| Rate for Payer: Health EOS Commercial |
$3,876.41
|
| Rate for Payer: HFN Commercial |
$4,007.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,266.64
|
| Rate for Payer: Multiplan Commercial |
$3,484.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,613.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,007.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.20
|
| Rate for Payer: Quartz Commercial |
$2,831.09
|
| Rate for Payer: Quartz Medicare Advantage |
$2,613.31
|
| Rate for Payer: The Alliance Commercial |
$2,177.76
|
| Rate for Payer: WEA Trust Commercial |
$2,395.54
|
| Rate for Payer: WPS Commercial |
$3,226.02
|
|
|
DRILL BIT 6.5 CONICAL W STOP
|
Facility
|
IP
|
$4,188.00
|
|
| Hospital Charge Code |
2966215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,134.20 |
| Max. Negotiated Rate |
$4,007.08 |
| Rate for Payer: Aetna Commercial |
$3,919.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,745.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,308.43
|
| Rate for Payer: Cash Price |
$1,256.40
|
| Rate for Payer: Cigna Commercial |
$4,007.08
|
| Rate for Payer: Health EOS Commercial |
$3,876.41
|
| Rate for Payer: HFN Commercial |
$4,007.08
|
| Rate for Payer: Multiplan Commercial |
$3,484.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,007.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.20
|
| Rate for Payer: Quartz Commercial |
$2,613.31
|
| Rate for Payer: WEA Trust Commercial |
$2,395.54
|
| Rate for Payer: WPS Commercial |
$3,226.02
|
|
|
DRILL BIT 6MM/9MM CANN STEPPED 03.037.022
|
Facility
|
IP
|
$5,742.00
|
|
| Hospital Charge Code |
5178628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,926.12 |
| Max. Negotiated Rate |
$5,493.95 |
| Rate for Payer: Aetna Commercial |
$5,374.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,135.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,164.99
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Cigna Commercial |
$5,493.95
|
| Rate for Payer: Health EOS Commercial |
$5,314.80
|
| Rate for Payer: HFN Commercial |
$5,493.95
|
| Rate for Payer: Multiplan Commercial |
$4,777.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,493.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,926.12
|
| Rate for Payer: Quartz Commercial |
$3,583.01
|
| Rate for Payer: WEA Trust Commercial |
$3,284.42
|
| Rate for Payer: WPS Commercial |
$4,423.06
|
|
|
DRILL BIT 6MM/9MM CANN STEPPED 03.037.022
|
Facility
|
OP
|
$5,742.00
|
|
| Hospital Charge Code |
5178628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.07 |
| Max. Negotiated Rate |
$5,493.95 |
| Rate for Payer: Aetna Commercial |
$5,374.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,135.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,672.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,881.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,866.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,164.99
|
| Rate for Payer: Cash Price |
$1,722.60
|
| Rate for Payer: Cigna Commercial |
$5,493.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,341.84
|
| Rate for Payer: Health EOS Commercial |
$5,314.80
|
| Rate for Payer: HFN Commercial |
$5,493.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,478.76
|
| Rate for Payer: Multiplan Commercial |
$4,777.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,583.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,493.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,926.12
|
| Rate for Payer: Quartz Commercial |
$3,881.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,583.01
|
| Rate for Payer: The Alliance Commercial |
$2,985.84
|
| Rate for Payer: WEA Trust Commercial |
$3,284.42
|
| Rate for Payer: WPS Commercial |
$4,423.06
|
|
|
DRILL BIT 7.3MM LARGE QC/300MM 310.495
|
Facility
|
OP
|
$5,068.00
|
|
| Hospital Charge Code |
4067879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,475.80 |
| Max. Negotiated Rate |
$4,849.06 |
| Rate for Payer: Aetna Commercial |
$4,743.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,425.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,635.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,529.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.48
|
| Rate for Payer: Cash Price |
$1,520.40
|
| Rate for Payer: Cigna Commercial |
$4,849.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,949.58
|
| Rate for Payer: Health EOS Commercial |
$4,690.94
|
| Rate for Payer: HFN Commercial |
$4,849.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,953.04
|
| Rate for Payer: Multiplan Commercial |
$4,216.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,849.06
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.65
|
| Rate for Payer: Quartz Commercial |
$3,425.97
|
| Rate for Payer: Quartz Medicare Advantage |
$3,162.43
|
| Rate for Payer: The Alliance Commercial |
$2,635.36
|
| Rate for Payer: WEA Trust Commercial |
$2,898.90
|
| Rate for Payer: WPS Commercial |
$3,903.88
|
|
|
DRILL BIT 7.3MM LARGE QC/300MM 310.495
|
Facility
|
IP
|
$5,068.00
|
|
| Hospital Charge Code |
4067879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,582.65 |
| Max. Negotiated Rate |
$4,849.06 |
| Rate for Payer: Aetna Commercial |
$4,743.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.48
|
| Rate for Payer: Cash Price |
$1,520.40
|
| Rate for Payer: Cigna Commercial |
$4,849.06
|
| Rate for Payer: Health EOS Commercial |
$4,690.94
|
| Rate for Payer: HFN Commercial |
$4,849.06
|
| Rate for Payer: Multiplan Commercial |
$4,216.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,849.06
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.65
|
| Rate for Payer: Quartz Commercial |
$3,162.43
|
| Rate for Payer: WEA Trust Commercial |
$2,898.90
|
| Rate for Payer: WPS Commercial |
$3,903.88
|
|
|
DRILL BIT 7.4x200MM SYNTHES
|
Facility
|
IP
|
$2,402.00
|
|
| Hospital Charge Code |
2966216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,224.06 |
| Max. Negotiated Rate |
$2,298.23 |
| Rate for Payer: Aetna Commercial |
$2,248.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.98
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,298.23
|
| Rate for Payer: Health EOS Commercial |
$2,223.29
|
| Rate for Payer: HFN Commercial |
$2,298.23
|
| Rate for Payer: Multiplan Commercial |
$1,998.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.06
|
| Rate for Payer: Quartz Commercial |
$1,498.85
|
| Rate for Payer: WEA Trust Commercial |
$1,373.94
|
| Rate for Payer: WPS Commercial |
$1,850.26
|
|
|
DRILL BIT 7.4x200MM SYNTHES
|
Facility
|
OP
|
$2,402.00
|
|
| Hospital Charge Code |
2966216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.46 |
| Max. Negotiated Rate |
$2,298.23 |
| Rate for Payer: Aetna Commercial |
$2,248.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.35
|
| Rate for Payer: Aetna Managed Medicare |
$699.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,623.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,249.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,199.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.98
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,298.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,397.96
|
| Rate for Payer: Health EOS Commercial |
$2,223.29
|
| Rate for Payer: HFN Commercial |
$2,298.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,873.56
|
| Rate for Payer: Multiplan Commercial |
$1,998.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.06
|
| Rate for Payer: Quartz Commercial |
$1,623.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,498.85
|
| Rate for Payer: The Alliance Commercial |
$1,249.04
|
| Rate for Payer: WEA Trust Commercial |
$1,373.94
|
| Rate for Payer: WPS Commercial |
$1,850.26
|
|
|
DRILL BIT .76 MINI W/ 14MM STOP 316.294
|
Facility
|
IP
|
$2,245.00
|
|
| Hospital Charge Code |
2966171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,144.05 |
| Max. Negotiated Rate |
$2,148.02 |
| Rate for Payer: Aetna Commercial |
$2,101.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,007.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.44
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$2,148.02
|
| Rate for Payer: Health EOS Commercial |
$2,077.97
|
| Rate for Payer: HFN Commercial |
$2,148.02
|
| Rate for Payer: Multiplan Commercial |
$1,867.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.05
|
| Rate for Payer: Quartz Commercial |
$1,400.88
|
| Rate for Payer: WEA Trust Commercial |
$1,284.14
|
| Rate for Payer: WPS Commercial |
$1,729.32
|
|
|
DRILL BIT .76 MINI W/ 14MM STOP 316.294
|
Facility
|
OP
|
$2,245.00
|
|
| Hospital Charge Code |
2966171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.74 |
| Max. Negotiated Rate |
$2,148.02 |
| Rate for Payer: Aetna Commercial |
$2,101.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,007.93
|
| Rate for Payer: Aetna Managed Medicare |
$653.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,517.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,167.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,120.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.44
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$2,148.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,306.59
|
| Rate for Payer: Health EOS Commercial |
$2,077.97
|
| Rate for Payer: HFN Commercial |
$2,148.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,751.10
|
| Rate for Payer: Multiplan Commercial |
$1,867.84
|
| Rate for Payer: NAPHCARE Commercial |
$1,400.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.05
|
| Rate for Payer: Quartz Commercial |
$1,517.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,400.88
|
| Rate for Payer: The Alliance Commercial |
$1,167.40
|
| Rate for Payer: WEA Trust Commercial |
$1,284.14
|
| Rate for Payer: WPS Commercial |
$1,729.32
|
|
|
DRILL BIT AO 4.2 X 180MM 1806-4270S
|
Facility
|
IP
|
$2,028.00
|
|
| Hospital Charge Code |
3072446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.47 |
| Max. Negotiated Rate |
$1,940.39 |
| Rate for Payer: Aetna Commercial |
$1,898.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,813.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,117.83
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$1,940.39
|
| Rate for Payer: Health EOS Commercial |
$1,877.12
|
| Rate for Payer: HFN Commercial |
$1,940.39
|
| Rate for Payer: Multiplan Commercial |
$1,687.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,940.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.47
|
| Rate for Payer: Quartz Commercial |
$1,265.47
|
| Rate for Payer: WEA Trust Commercial |
$1,160.02
|
| Rate for Payer: WPS Commercial |
$1,562.17
|
|
|
DRILL BIT AO 4.2 X 180MM 1806-4270S
|
Facility
|
OP
|
$2,028.00
|
|
| Hospital Charge Code |
3072446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.55 |
| Max. Negotiated Rate |
$1,940.39 |
| Rate for Payer: Aetna Commercial |
$1,898.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,813.84
|
| Rate for Payer: Aetna Managed Medicare |
$590.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,370.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,054.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,012.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,117.83
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$1,940.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,180.30
|
| Rate for Payer: Health EOS Commercial |
$1,877.12
|
| Rate for Payer: HFN Commercial |
$1,940.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,581.84
|
| Rate for Payer: Multiplan Commercial |
$1,687.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,265.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,940.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.47
|
| Rate for Payer: Quartz Commercial |
$1,370.93
|
| Rate for Payer: Quartz Medicare Advantage |
$1,265.47
|
| Rate for Payer: The Alliance Commercial |
$1,054.56
|
| Rate for Payer: WEA Trust Commercial |
$1,160.02
|
| Rate for Payer: WPS Commercial |
$1,562.17
|
|
|
DRILL BIT #ATF-032
|
Facility
|
OP
|
$1,153.00
|
|
| Hospital Charge Code |
2964137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.75 |
| Max. Negotiated Rate |
$1,103.19 |
| Rate for Payer: Aetna Commercial |
$1,079.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Aetna Managed Medicare |
$335.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$779.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.53
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,103.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$671.05
|
| Rate for Payer: Health EOS Commercial |
$1,067.22
|
| Rate for Payer: HFN Commercial |
$1,103.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$899.34
|
| Rate for Payer: Multiplan Commercial |
$959.30
|
| Rate for Payer: NAPHCARE Commercial |
$719.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.19
|
| Rate for Payer: Quartz Beloit One Network |
$587.57
|
| Rate for Payer: Quartz Commercial |
$779.43
|
| Rate for Payer: Quartz Medicare Advantage |
$719.47
|
| Rate for Payer: The Alliance Commercial |
$599.56
|
| Rate for Payer: WEA Trust Commercial |
$659.52
|
| Rate for Payer: WPS Commercial |
$888.16
|
|
|
DRILL BIT #ATF-032
|
Facility
|
IP
|
$1,153.00
|
|
| Hospital Charge Code |
2964137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$587.57 |
| Max. Negotiated Rate |
$1,103.19 |
| Rate for Payer: Aetna Commercial |
$1,079.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.53
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,103.19
|
| Rate for Payer: Health EOS Commercial |
$1,067.22
|
| Rate for Payer: HFN Commercial |
$1,103.19
|
| Rate for Payer: Multiplan Commercial |
$959.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.19
|
| Rate for Payer: Quartz Beloit One Network |
$587.57
|
| Rate for Payer: Quartz Commercial |
$719.47
|
| Rate for Payer: WEA Trust Commercial |
$659.52
|
| Rate for Payer: WPS Commercial |
$888.16
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 20MM AR-5025TDC
|
Facility
|
IP
|
$1,740.00
|
|
| Hospital Charge Code |
6220123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.70 |
| Max. Negotiated Rate |
$1,664.83 |
| Rate for Payer: Aetna Commercial |
$1,628.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.09
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,664.83
|
| Rate for Payer: Health EOS Commercial |
$1,610.54
|
| Rate for Payer: HFN Commercial |
$1,664.83
|
| Rate for Payer: Multiplan Commercial |
$1,447.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.83
|
| Rate for Payer: Quartz Beloit One Network |
$886.70
|
| Rate for Payer: Quartz Commercial |
$1,085.76
|
| Rate for Payer: WEA Trust Commercial |
$995.28
|
| Rate for Payer: WPS Commercial |
$1,340.32
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 20MM AR-5025TDC
|
Facility
|
OP
|
$1,740.00
|
|
| Hospital Charge Code |
6220123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$1,664.83 |
| Rate for Payer: Aetna Commercial |
$1,628.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.26
|
| Rate for Payer: Aetna Managed Medicare |
$506.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,176.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.09
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,664.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.68
|
| Rate for Payer: Health EOS Commercial |
$1,610.54
|
| Rate for Payer: HFN Commercial |
$1,664.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.20
|
| Rate for Payer: Multiplan Commercial |
$1,447.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.83
|
| Rate for Payer: Quartz Beloit One Network |
$886.70
|
| Rate for Payer: Quartz Commercial |
$1,176.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.76
|
| Rate for Payer: The Alliance Commercial |
$904.80
|
| Rate for Payer: WEA Trust Commercial |
$995.28
|
| Rate for Payer: WPS Commercial |
$1,340.32
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 22MM AR-5025TDC-22
|
Facility
|
OP
|
$1,723.00
|
|
| Hospital Charge Code |
6177773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.74 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$501.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.79
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.94
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,164.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.15
|
| Rate for Payer: The Alliance Commercial |
$895.96
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
DRILL BIT BIO-COMPOSITE SCREW 22MM AR-5025TDC-22
|
Facility
|
IP
|
$1,723.00
|
|
| Hospital Charge Code |
6177773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.04 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,075.15
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
DRILL BIT BIO-SUTURE TAK AR-1250LT
|
Facility
|
IP
|
$1,647.00
|
|
| Hospital Charge Code |
2964713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| 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: 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: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
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
|
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 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 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
|
|
