|
DRILL BIT D 2.0MM 299005ND
|
Facility
|
OP
|
$3,402.00
|
|
| Hospital Charge Code |
5617665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$990.66 |
| Max. Negotiated Rate |
$3,255.03 |
| Rate for Payer: The Alliance Commercial |
$1,769.04
|
| Rate for Payer: Aetna Commercial |
$3,184.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,042.75
|
| Rate for Payer: Aetna Managed Medicare |
$990.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,299.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,769.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,698.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.18
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$3,255.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,979.96
|
| Rate for Payer: Health EOS Commercial |
$3,148.89
|
| Rate for Payer: HFN Commercial |
$3,255.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,653.56
|
| Rate for Payer: Multiplan Commercial |
$2,830.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,122.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,255.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.66
|
| Rate for Payer: Quartz Commercial |
$2,299.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,122.85
|
| Rate for Payer: WEA Trust Commercial |
$1,945.94
|
| Rate for Payer: WPS Commercial |
$2,620.56
|
|
|
DRILL BIT D2.8 1910-1270S
|
Facility
|
IP
|
$3,140.00
|
|
| Hospital Charge Code |
5831820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,600.14 |
| Max. Negotiated Rate |
$3,004.35 |
| Rate for Payer: Aetna Commercial |
$2,939.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,808.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.77
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$3,004.35
|
| Rate for Payer: Health EOS Commercial |
$2,906.38
|
| Rate for Payer: HFN Commercial |
$3,004.35
|
| Rate for Payer: Multiplan Commercial |
$2,612.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,004.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,600.14
|
| Rate for Payer: Quartz Commercial |
$1,959.36
|
| Rate for Payer: WEA Trust Commercial |
$1,796.08
|
| Rate for Payer: WPS Commercial |
$2,418.74
|
|
|
DRILL BIT D2.8 1910-1270S
|
Facility
|
OP
|
$3,140.00
|
|
| Hospital Charge Code |
5831820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.37 |
| Max. Negotiated Rate |
$3,004.35 |
| Rate for Payer: Aetna Commercial |
$2,939.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,808.42
|
| Rate for Payer: Aetna Managed Medicare |
$914.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,122.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,567.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.77
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$3,004.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,827.48
|
| Rate for Payer: Health EOS Commercial |
$2,906.38
|
| Rate for Payer: HFN Commercial |
$3,004.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,449.20
|
| Rate for Payer: Multiplan Commercial |
$2,612.48
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,004.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,600.14
|
| Rate for Payer: Quartz Commercial |
$2,122.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,959.36
|
| Rate for Payer: The Alliance Commercial |
$1,632.80
|
| Rate for Payer: WEA Trust Commercial |
$1,796.08
|
| Rate for Payer: WPS Commercial |
$2,418.74
|
|
|
DRILL BIT DHS/DCS 8.0MM TRIPLE REAMER 338.10
|
Facility
|
IP
|
$4,515.00
|
|
| Hospital Charge Code |
5178633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,300.84 |
| Max. Negotiated Rate |
$4,319.95 |
| Rate for Payer: Aetna Commercial |
$4,226.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,038.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,488.67
|
| Rate for Payer: Cash Price |
$1,354.50
|
| Rate for Payer: Cigna Commercial |
$4,319.95
|
| Rate for Payer: Health EOS Commercial |
$4,179.08
|
| Rate for Payer: HFN Commercial |
$4,319.95
|
| Rate for Payer: Multiplan Commercial |
$3,756.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,319.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,300.84
|
| Rate for Payer: Quartz Commercial |
$2,817.36
|
| Rate for Payer: WEA Trust Commercial |
$2,582.58
|
| Rate for Payer: WPS Commercial |
$3,477.90
|
|
|
DRILL BIT DHS/DCS 8.0MM TRIPLE REAMER 338.10
|
Facility
|
OP
|
$4,515.00
|
|
| Hospital Charge Code |
5178633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,314.77 |
| Max. Negotiated Rate |
$4,319.95 |
| Rate for Payer: Aetna Commercial |
$4,226.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,038.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,314.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,052.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,347.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,253.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,488.67
|
| Rate for Payer: Cash Price |
$1,354.50
|
| Rate for Payer: Cigna Commercial |
$4,319.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,627.73
|
| Rate for Payer: Health EOS Commercial |
$4,179.08
|
| Rate for Payer: HFN Commercial |
$4,319.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,521.70
|
| Rate for Payer: Multiplan Commercial |
$3,756.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,817.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,319.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,300.84
|
| Rate for Payer: Quartz Commercial |
$3,052.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,817.36
|
| Rate for Payer: The Alliance Commercial |
$2,347.80
|
| Rate for Payer: WEA Trust Commercial |
$2,582.58
|
| Rate for Payer: WPS Commercial |
$3,477.90
|
|
|
DRILL BIT FLEXIBLE 12MM LONG 03.043.016
|
Facility
|
OP
|
$6,145.00
|
|
| Hospital Charge Code |
6180621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,789.42 |
| Max. Negotiated Rate |
$5,879.54 |
| Rate for Payer: Aetna Commercial |
$5,751.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,789.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,154.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,195.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,067.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,387.12
|
| Rate for Payer: Cash Price |
$1,843.50
|
| Rate for Payer: Cigna Commercial |
$5,879.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,576.39
|
| Rate for Payer: Health EOS Commercial |
$5,687.81
|
| Rate for Payer: HFN Commercial |
$5,879.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,793.10
|
| Rate for Payer: Multiplan Commercial |
$5,112.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,834.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,879.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,131.49
|
| Rate for Payer: Quartz Commercial |
$4,154.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,834.48
|
| Rate for Payer: The Alliance Commercial |
$3,195.40
|
| Rate for Payer: WEA Trust Commercial |
$3,514.94
|
| Rate for Payer: WPS Commercial |
$4,733.49
|
|
|
DRILL BIT FLEXIBLE 12MM LONG 03.043.016
|
Facility
|
IP
|
$6,145.00
|
|
| Hospital Charge Code |
6180621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,131.49 |
| Max. Negotiated Rate |
$5,879.54 |
| Rate for Payer: Aetna Commercial |
$5,751.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,387.12
|
| Rate for Payer: Cash Price |
$1,843.50
|
| Rate for Payer: Cigna Commercial |
$5,879.54
|
| Rate for Payer: Health EOS Commercial |
$5,687.81
|
| Rate for Payer: HFN Commercial |
$5,879.54
|
| Rate for Payer: Multiplan Commercial |
$5,112.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,879.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,131.49
|
| Rate for Payer: Quartz Commercial |
$3,834.48
|
| Rate for Payer: WEA Trust Commercial |
$3,514.94
|
| Rate for Payer: WPS Commercial |
$4,733.49
|
|
|
DRILL BIT FOR 3.5MM SWIVELOCK AR-2325D
|
Facility
|
OP
|
$1,810.00
|
|
| Hospital Charge Code |
5591322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.07 |
| Max. Negotiated Rate |
$1,731.81 |
| Rate for Payer: Aetna Commercial |
$1,694.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.86
|
| Rate for Payer: Aetna Managed Medicare |
$527.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.67
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$1,731.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.42
|
| Rate for Payer: Health EOS Commercial |
$1,675.34
|
| Rate for Payer: HFN Commercial |
$1,731.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.80
|
| Rate for Payer: Multiplan Commercial |
$1,505.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.81
|
| Rate for Payer: Quartz Beloit One Network |
$922.38
|
| Rate for Payer: Quartz Commercial |
$1,223.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.44
|
| Rate for Payer: The Alliance Commercial |
$941.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.32
|
| Rate for Payer: WPS Commercial |
$1,394.24
|
|
|
DRILL BIT FOR 3.5MM SWIVELOCK AR-2325D
|
Facility
|
IP
|
$1,810.00
|
|
| Hospital Charge Code |
5591322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.38 |
| Max. Negotiated Rate |
$1,731.81 |
| Rate for Payer: Aetna Commercial |
$1,694.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.67
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$1,731.81
|
| Rate for Payer: Health EOS Commercial |
$1,675.34
|
| Rate for Payer: HFN Commercial |
$1,731.81
|
| Rate for Payer: Multiplan Commercial |
$1,505.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.81
|
| Rate for Payer: Quartz Beloit One Network |
$922.38
|
| Rate for Payer: Quartz Commercial |
$1,129.44
|
| Rate for Payer: WEA Trust Commercial |
$1,035.32
|
| Rate for Payer: WPS Commercial |
$1,394.24
|
|
|
DRILL BIT GAMMA 4.2 X 300MM 1320-3042S
|
Facility
|
OP
|
$2,029.00
|
|
| Hospital Charge Code |
3785550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.84 |
| Max. Negotiated Rate |
$1,941.35 |
| Rate for Payer: Aetna Commercial |
$1,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,814.74
|
| Rate for Payer: Aetna Managed Medicare |
$590.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,371.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,055.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,012.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.38
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,941.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,180.88
|
| Rate for Payer: Health EOS Commercial |
$1,878.04
|
| Rate for Payer: HFN Commercial |
$1,941.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,582.62
|
| Rate for Payer: Multiplan Commercial |
$1,688.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,266.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.98
|
| Rate for Payer: Quartz Commercial |
$1,371.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,266.10
|
| Rate for Payer: The Alliance Commercial |
$1,055.08
|
| Rate for Payer: WEA Trust Commercial |
$1,160.59
|
| Rate for Payer: WPS Commercial |
$1,562.94
|
|
|
DRILL BIT GAMMA 4.2 X 300MM 1320-3042S
|
Facility
|
IP
|
$2,029.00
|
|
| Hospital Charge Code |
3785550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.98 |
| Max. Negotiated Rate |
$1,941.35 |
| Rate for Payer: Aetna Commercial |
$1,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,814.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.38
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,941.35
|
| Rate for Payer: Health EOS Commercial |
$1,878.04
|
| Rate for Payer: HFN Commercial |
$1,941.35
|
| Rate for Payer: Multiplan Commercial |
$1,688.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.98
|
| Rate for Payer: Quartz Commercial |
$1,266.10
|
| Rate for Payer: WEA Trust Commercial |
$1,160.59
|
| Rate for Payer: WPS Commercial |
$1,562.94
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 4MM STOP 03.503.244
|
Facility
|
IP
|
$1,299.00
|
|
| Hospital Charge Code |
5264681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.97 |
| Max. Negotiated Rate |
$1,242.88 |
| Rate for Payer: Aetna Commercial |
$1,215.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.01
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,242.88
|
| Rate for Payer: Health EOS Commercial |
$1,202.35
|
| Rate for Payer: HFN Commercial |
$1,242.88
|
| Rate for Payer: Multiplan Commercial |
$1,080.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.88
|
| Rate for Payer: Quartz Beloit One Network |
$661.97
|
| Rate for Payer: Quartz Commercial |
$810.58
|
| Rate for Payer: WEA Trust Commercial |
$743.03
|
| Rate for Payer: WPS Commercial |
$1,000.62
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 4MM STOP 03.503.244
|
Facility
|
OP
|
$1,299.00
|
|
| Hospital Charge Code |
5264681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.27 |
| Max. Negotiated Rate |
$1,242.88 |
| Rate for Payer: Aetna Commercial |
$1,215.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.83
|
| Rate for Payer: Aetna Managed Medicare |
$378.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$878.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$675.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$648.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.01
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,242.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$756.02
|
| Rate for Payer: Health EOS Commercial |
$1,202.35
|
| Rate for Payer: HFN Commercial |
$1,242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,013.22
|
| Rate for Payer: Multiplan Commercial |
$1,080.77
|
| Rate for Payer: NAPHCARE Commercial |
$810.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.88
|
| Rate for Payer: Quartz Beloit One Network |
$661.97
|
| Rate for Payer: Quartz Commercial |
$878.12
|
| Rate for Payer: Quartz Medicare Advantage |
$810.58
|
| Rate for Payer: The Alliance Commercial |
$675.48
|
| Rate for Payer: WEA Trust Commercial |
$743.03
|
| Rate for Payer: WPS Commercial |
$1,000.62
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 6MM STOP 03.503.246
|
Facility
|
IP
|
$1,299.00
|
|
| Hospital Charge Code |
5264664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.97 |
| Max. Negotiated Rate |
$1,242.88 |
| Rate for Payer: Aetna Commercial |
$1,215.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.01
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,242.88
|
| Rate for Payer: Health EOS Commercial |
$1,202.35
|
| Rate for Payer: HFN Commercial |
$1,242.88
|
| Rate for Payer: Multiplan Commercial |
$1,080.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.88
|
| Rate for Payer: Quartz Beloit One Network |
$661.97
|
| Rate for Payer: Quartz Commercial |
$810.58
|
| Rate for Payer: WEA Trust Commercial |
$743.03
|
| Rate for Payer: WPS Commercial |
$1,000.62
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 6MM STOP 03.503.246
|
Facility
|
OP
|
$1,299.00
|
|
| Hospital Charge Code |
5264664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.27 |
| Max. Negotiated Rate |
$1,242.88 |
| Rate for Payer: Aetna Commercial |
$1,215.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.83
|
| Rate for Payer: Aetna Managed Medicare |
$378.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$878.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$675.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$648.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.01
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,242.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$756.02
|
| Rate for Payer: Health EOS Commercial |
$1,202.35
|
| Rate for Payer: HFN Commercial |
$1,242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,013.22
|
| Rate for Payer: Multiplan Commercial |
$1,080.77
|
| Rate for Payer: NAPHCARE Commercial |
$810.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.88
|
| Rate for Payer: Quartz Beloit One Network |
$661.97
|
| Rate for Payer: Quartz Commercial |
$878.12
|
| Rate for Payer: Quartz Medicare Advantage |
$810.58
|
| Rate for Payer: The Alliance Commercial |
$675.48
|
| Rate for Payer: WEA Trust Commercial |
$743.03
|
| Rate for Payer: WPS Commercial |
$1,000.62
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 8MM STOP 03.503.248
|
Facility
|
OP
|
$1,299.00
|
|
| Hospital Charge Code |
5306788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.27 |
| Max. Negotiated Rate |
$1,242.88 |
| Rate for Payer: Aetna Commercial |
$1,215.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.83
|
| Rate for Payer: Aetna Managed Medicare |
$378.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$878.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$675.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$648.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.01
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,242.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$756.02
|
| Rate for Payer: Health EOS Commercial |
$1,202.35
|
| Rate for Payer: HFN Commercial |
$1,242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,013.22
|
| Rate for Payer: Multiplan Commercial |
$1,080.77
|
| Rate for Payer: NAPHCARE Commercial |
$810.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.88
|
| Rate for Payer: Quartz Beloit One Network |
$661.97
|
| Rate for Payer: Quartz Commercial |
$878.12
|
| Rate for Payer: Quartz Medicare Advantage |
$810.58
|
| Rate for Payer: The Alliance Commercial |
$675.48
|
| Rate for Payer: WEA Trust Commercial |
$743.03
|
| Rate for Payer: WPS Commercial |
$1,000.62
|
|
|
DRILL BIT J-LATCH MATRIX 1.1MM X 44.5MM WITH 8MM STOP 03.503.248
|
Facility
|
IP
|
$1,299.00
|
|
| Hospital Charge Code |
5306788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.97 |
| Max. Negotiated Rate |
$1,242.88 |
| Rate for Payer: Aetna Commercial |
$1,215.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.01
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Cigna Commercial |
$1,242.88
|
| Rate for Payer: Health EOS Commercial |
$1,202.35
|
| Rate for Payer: HFN Commercial |
$1,242.88
|
| Rate for Payer: Multiplan Commercial |
$1,080.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.88
|
| Rate for Payer: Quartz Beloit One Network |
$661.97
|
| Rate for Payer: Quartz Commercial |
$810.58
|
| Rate for Payer: WEA Trust Commercial |
$743.03
|
| Rate for Payer: WPS Commercial |
$1,000.62
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 125MM CALIBRATED 03.503.476
|
Facility
|
IP
|
$3,283.00
|
|
| Hospital Charge Code |
5831675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 125MM CALIBRATED 03.503.476
|
Facility
|
OP
|
$3,283.00
|
|
| Hospital Charge Code |
5831675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 50MM WITH 6MM STOP 03.503.406
|
Facility
|
OP
|
$2,649.00
|
|
| Hospital Charge Code |
4038110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$771.39 |
| Max. Negotiated Rate |
$2,534.56 |
| Rate for Payer: Aetna Commercial |
$2,479.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,369.27
|
| Rate for Payer: Aetna Managed Medicare |
$771.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,790.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,377.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,322.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,460.13
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cigna Commercial |
$2,534.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,541.72
|
| Rate for Payer: Health EOS Commercial |
$2,451.91
|
| Rate for Payer: HFN Commercial |
$2,534.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,066.22
|
| Rate for Payer: Multiplan Commercial |
$2,203.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,652.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,349.93
|
| Rate for Payer: Quartz Commercial |
$1,790.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,652.98
|
| Rate for Payer: The Alliance Commercial |
$1,377.48
|
| Rate for Payer: WEA Trust Commercial |
$1,515.23
|
| Rate for Payer: WPS Commercial |
$2,040.52
|
|
|
DRILL BIT J-LATCH MATRIX 1.5MM X 50MM WITH 6MM STOP 03.503.406
|
Facility
|
IP
|
$2,649.00
|
|
| Hospital Charge Code |
4038110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,349.93 |
| Max. Negotiated Rate |
$2,534.56 |
| Rate for Payer: Aetna Commercial |
$2,479.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,369.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,460.13
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cigna Commercial |
$2,534.56
|
| Rate for Payer: Health EOS Commercial |
$2,451.91
|
| Rate for Payer: HFN Commercial |
$2,534.56
|
| Rate for Payer: Multiplan Commercial |
$2,203.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,349.93
|
| Rate for Payer: Quartz Commercial |
$1,652.98
|
| Rate for Payer: WEA Trust Commercial |
$1,515.23
|
| Rate for Payer: WPS Commercial |
$2,040.52
|
|
|
DRILL BIT J-LATCH MATRIX 1.8MM X 125MM 03.503.477
|
Facility
|
OP
|
$3,283.00
|
|
| Hospital Charge Code |
5831676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
DRILL BIT J-LATCH MATRIX 1.8MM X 125MM 03.503.477
|
Facility
|
IP
|
$3,283.00
|
|
| Hospital Charge Code |
5831676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
DRILL BIT LONG ACUTRAK 2 AT2-L2525
|
Facility
|
OP
|
$3,149.00
|
|
| Hospital Charge Code |
2964136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.99 |
| Max. Negotiated Rate |
$3,012.96 |
| Rate for Payer: Aetna Commercial |
$2,947.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Aetna Managed Medicare |
$916.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,128.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,637.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,571.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.73
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,012.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,832.72
|
| Rate for Payer: Health EOS Commercial |
$2,914.71
|
| Rate for Payer: HFN Commercial |
$3,012.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,456.22
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,964.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.73
|
| Rate for Payer: Quartz Commercial |
$2,128.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,964.98
|
| Rate for Payer: The Alliance Commercial |
$1,637.48
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,425.67
|
|
|
DRILL BIT LONG ACUTRAK 2 AT2-L2525
|
Facility
|
IP
|
$3,149.00
|
|
| Hospital Charge Code |
2964136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,604.73 |
| Max. Negotiated Rate |
$3,012.96 |
| Rate for Payer: Aetna Commercial |
$2,947.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.73
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,012.96
|
| Rate for Payer: Health EOS Commercial |
$2,914.71
|
| Rate for Payer: HFN Commercial |
$3,012.96
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.73
|
| Rate for Payer: Quartz Commercial |
$1,964.98
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,425.67
|
|
