|
DRILL BIT MATRIX 1.25MM 03.503.121
|
Facility
|
IP
|
$1,466.00
|
|
| Hospital Charge Code |
5298652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.07 |
| Max. Negotiated Rate |
$1,402.67 |
| Rate for Payer: Aetna Commercial |
$1,372.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.06
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,402.67
|
| Rate for Payer: Health EOS Commercial |
$1,356.93
|
| Rate for Payer: HFN Commercial |
$1,402.67
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.67
|
| Rate for Payer: Quartz Beloit One Network |
$747.07
|
| Rate for Payer: Quartz Commercial |
$914.78
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,129.26
|
|
|
DRILL BIT MATRIX 1.25MM 03.503.121
|
Facility
|
OP
|
$1,466.00
|
|
| Hospital Charge Code |
5298652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.90 |
| Max. Negotiated Rate |
$1,402.67 |
| Rate for Payer: Aetna Commercial |
$1,372.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Aetna Managed Medicare |
$426.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.06
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,402.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.21
|
| Rate for Payer: Health EOS Commercial |
$1,356.93
|
| Rate for Payer: HFN Commercial |
$1,402.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.48
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: NAPHCARE Commercial |
$914.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.67
|
| Rate for Payer: Quartz Beloit One Network |
$747.07
|
| Rate for Payer: Quartz Commercial |
$991.02
|
| Rate for Payer: Quartz Medicare Advantage |
$914.78
|
| Rate for Payer: The Alliance Commercial |
$762.32
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,129.26
|
|
|
DRILL BIT MEMOFIX 1.7MM MS2610
|
Facility
|
OP
|
$4,878.00
|
|
| Hospital Charge Code |
5521016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,420.47 |
| Max. Negotiated Rate |
$4,667.27 |
| Rate for Payer: Aetna Commercial |
$4,565.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,362.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,420.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,297.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,536.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,435.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,688.75
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,667.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,839.00
|
| Rate for Payer: Health EOS Commercial |
$4,515.08
|
| Rate for Payer: HFN Commercial |
$4,667.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,804.84
|
| Rate for Payer: Multiplan Commercial |
$4,058.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,043.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,667.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,485.83
|
| Rate for Payer: Quartz Commercial |
$3,297.53
|
| Rate for Payer: Quartz Medicare Advantage |
$3,043.87
|
| Rate for Payer: The Alliance Commercial |
$2,536.56
|
| Rate for Payer: WEA Trust Commercial |
$2,790.22
|
| Rate for Payer: WPS Commercial |
$3,757.52
|
|
|
DRILL BIT MEMOFIX 1.7MM MS2610
|
Facility
|
IP
|
$4,878.00
|
|
| Hospital Charge Code |
5521016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,485.83 |
| Max. Negotiated Rate |
$4,667.27 |
| Rate for Payer: Aetna Commercial |
$4,565.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,362.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,688.75
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,667.27
|
| Rate for Payer: Health EOS Commercial |
$4,515.08
|
| Rate for Payer: HFN Commercial |
$4,667.27
|
| Rate for Payer: Multiplan Commercial |
$4,058.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,667.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,485.83
|
| Rate for Payer: Quartz Commercial |
$3,043.87
|
| Rate for Payer: WEA Trust Commercial |
$2,790.22
|
| Rate for Payer: WPS Commercial |
$3,757.52
|
|
|
DRILL BIT MINI 1.8MM 80MM QC 317.861
|
Facility
|
OP
|
$792.00
|
|
| Hospital Charge Code |
4508846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$494.21
|
| Rate for Payer: The Alliance Commercial |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
DRILL BIT MINI 1.8MM 80MM QC 317.861
|
Facility
|
IP
|
$792.00
|
|
| Hospital Charge Code |
4508846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
DRILL BIT MINI 2.4MM 80MM QC 317.871
|
Facility
|
OP
|
$792.00
|
|
| Hospital Charge Code |
4508847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$494.21
|
| Rate for Payer: The Alliance Commercial |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
DRILL BIT MINI 2.4MM 80MM QC 317.871
|
Facility
|
IP
|
$792.00
|
|
| Hospital Charge Code |
4508847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
DRILL BIT MINI LONG ACUTRAK 2 AT2M-L1813
|
Facility
|
IP
|
$3,168.00
|
|
| Hospital Charge Code |
2964140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,614.41 |
| Max. Negotiated Rate |
$3,031.14 |
| Rate for Payer: Aetna Commercial |
$2,965.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,833.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,746.20
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$3,031.14
|
| Rate for Payer: Health EOS Commercial |
$2,932.30
|
| Rate for Payer: HFN Commercial |
$3,031.14
|
| Rate for Payer: Multiplan Commercial |
$2,635.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,031.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.41
|
| Rate for Payer: Quartz Commercial |
$1,976.83
|
| Rate for Payer: WEA Trust Commercial |
$1,812.10
|
| Rate for Payer: WPS Commercial |
$2,440.31
|
|
|
DRILL BIT MINI LONG ACUTRAK 2 AT2M-L1813
|
Facility
|
OP
|
$3,168.00
|
|
| Hospital Charge Code |
2964140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.52 |
| Max. Negotiated Rate |
$3,031.14 |
| Rate for Payer: Aetna Commercial |
$2,965.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,833.46
|
| Rate for Payer: Aetna Managed Medicare |
$922.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,141.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,647.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,581.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,746.20
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cigna Commercial |
$3,031.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,843.78
|
| Rate for Payer: Health EOS Commercial |
$2,932.30
|
| Rate for Payer: HFN Commercial |
$3,031.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,471.04
|
| Rate for Payer: Multiplan Commercial |
$2,635.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,976.83
|
| Rate for Payer: Preferred Network Access Commercial |
$3,031.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,614.41
|
| Rate for Payer: Quartz Commercial |
$2,141.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,976.83
|
| Rate for Payer: The Alliance Commercial |
$1,647.36
|
| Rate for Payer: WEA Trust Commercial |
$1,812.10
|
| Rate for Payer: WPS Commercial |
$2,440.31
|
|
|
DRILL BIT OLECRANON OSTEOTOMY
|
Facility
|
OP
|
$5,137.00
|
|
| Hospital Charge Code |
2966217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,495.89 |
| Max. Negotiated Rate |
$4,915.08 |
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,594.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,495.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,472.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,671.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,564.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,831.51
|
| Rate for Payer: Cash Price |
$1,541.10
|
| Rate for Payer: Cigna Commercial |
$4,915.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,989.73
|
| Rate for Payer: Health EOS Commercial |
$4,754.81
|
| Rate for Payer: HFN Commercial |
$4,915.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,006.86
|
| Rate for Payer: Multiplan Commercial |
$4,273.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,205.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,915.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,617.82
|
| Rate for Payer: Quartz Commercial |
$3,472.61
|
| Rate for Payer: Quartz Medicare Advantage |
$3,205.49
|
| Rate for Payer: The Alliance Commercial |
$2,671.24
|
| Rate for Payer: WEA Trust Commercial |
$2,938.36
|
| Rate for Payer: WPS Commercial |
$3,957.03
|
|
|
DRILL BIT OLECRANON OSTEOTOMY
|
Facility
|
IP
|
$5,137.00
|
|
| Hospital Charge Code |
2966217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,617.82 |
| Max. Negotiated Rate |
$4,915.08 |
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,594.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,831.51
|
| Rate for Payer: Cash Price |
$1,541.10
|
| Rate for Payer: Cigna Commercial |
$4,915.08
|
| Rate for Payer: Health EOS Commercial |
$4,754.81
|
| Rate for Payer: HFN Commercial |
$4,915.08
|
| Rate for Payer: Multiplan Commercial |
$4,273.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,915.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,617.82
|
| Rate for Payer: Quartz Commercial |
$3,205.49
|
| Rate for Payer: WEA Trust Commercial |
$2,938.36
|
| Rate for Payer: WPS Commercial |
$3,957.03
|
|
|
DRILL BIT OPENING 5.5MM 2358-2000
|
Facility
|
IP
|
$4,190.00
|
|
| Hospital Charge Code |
6171932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,135.22 |
| Max. Negotiated Rate |
$4,008.99 |
| Rate for Payer: Aetna Commercial |
$3,921.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,747.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,309.53
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$4,008.99
|
| Rate for Payer: Health EOS Commercial |
$3,878.26
|
| Rate for Payer: HFN Commercial |
$4,008.99
|
| Rate for Payer: Multiplan Commercial |
$3,486.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,135.22
|
| Rate for Payer: Quartz Commercial |
$2,614.56
|
| Rate for Payer: WEA Trust Commercial |
$2,396.68
|
| Rate for Payer: WPS Commercial |
$3,227.56
|
|
|
DRILL BIT OPENING 5.5MM 2358-2000
|
Facility
|
OP
|
$4,190.00
|
|
| Hospital Charge Code |
6171932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,220.13 |
| Max. Negotiated Rate |
$4,008.99 |
| Rate for Payer: Aetna Commercial |
$3,921.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,747.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,220.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,832.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,178.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,091.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,309.53
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$4,008.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,438.58
|
| Rate for Payer: Health EOS Commercial |
$3,878.26
|
| Rate for Payer: HFN Commercial |
$4,008.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,268.20
|
| Rate for Payer: Multiplan Commercial |
$3,486.08
|
| Rate for Payer: NAPHCARE Commercial |
$2,614.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,135.22
|
| Rate for Payer: Quartz Commercial |
$2,832.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,614.56
|
| Rate for Payer: The Alliance Commercial |
$2,178.80
|
| Rate for Payer: WEA Trust Commercial |
$2,396.68
|
| Rate for Payer: WPS Commercial |
$3,227.56
|
|
|
DRILL BIT PERIPHERAL SCREW 2.7MM 405889
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
6165986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DRILL BIT PERIPHERAL SCREW 2.7MM 405889
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
6165986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DRILL BIT PILOT TRILLIANT 510-10-002
|
Facility
|
IP
|
$2,394.00
|
|
| Hospital Charge Code |
5414670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,219.98 |
| Max. Negotiated Rate |
$2,290.58 |
| Rate for Payer: Aetna Commercial |
$2,240.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.57
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,290.58
|
| Rate for Payer: Health EOS Commercial |
$2,215.89
|
| Rate for Payer: HFN Commercial |
$2,290.58
|
| Rate for Payer: Multiplan Commercial |
$1,991.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.98
|
| Rate for Payer: Quartz Commercial |
$1,493.86
|
| Rate for Payer: WEA Trust Commercial |
$1,369.37
|
| Rate for Payer: WPS Commercial |
$1,844.10
|
|
|
DRILL BIT PILOT TRILLIANT 510-10-002
|
Facility
|
OP
|
$2,394.00
|
|
| Hospital Charge Code |
5414670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.13 |
| Max. Negotiated Rate |
$2,290.58 |
| Rate for Payer: Aetna Commercial |
$2,240.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.19
|
| Rate for Payer: Aetna Managed Medicare |
$697.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,618.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,244.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,195.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.57
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,290.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,393.31
|
| Rate for Payer: Health EOS Commercial |
$2,215.89
|
| Rate for Payer: HFN Commercial |
$2,290.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,867.32
|
| Rate for Payer: Multiplan Commercial |
$1,991.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,493.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.98
|
| Rate for Payer: Quartz Commercial |
$1,618.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,493.86
|
| Rate for Payer: The Alliance Commercial |
$1,244.88
|
| Rate for Payer: WEA Trust Commercial |
$1,369.37
|
| Rate for Payer: WPS Commercial |
$1,844.10
|
|
|
DRILL BIT SCALED 2.6 X 220MM AO FIT 2358-0050
|
Facility
|
OP
|
$3,885.00
|
|
| Hospital Charge Code |
6171931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,131.31 |
| Max. Negotiated Rate |
$3,717.17 |
| Rate for Payer: Aetna Commercial |
$3,636.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,474.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,131.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,626.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,020.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,939.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.41
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna Commercial |
$3,717.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,261.07
|
| Rate for Payer: Health EOS Commercial |
$3,595.96
|
| Rate for Payer: HFN Commercial |
$3,717.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,030.30
|
| Rate for Payer: Multiplan Commercial |
$3,232.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,424.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,979.80
|
| Rate for Payer: Quartz Commercial |
$2,626.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,424.24
|
| Rate for Payer: The Alliance Commercial |
$2,020.20
|
| Rate for Payer: WEA Trust Commercial |
$2,222.22
|
| Rate for Payer: WPS Commercial |
$2,992.62
|
|
|
DRILL BIT SCALED 2.6 X 220MM AO FIT 2358-0050
|
Facility
|
IP
|
$3,885.00
|
|
| Hospital Charge Code |
6171931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,979.80 |
| Max. Negotiated Rate |
$3,717.17 |
| Rate for Payer: Aetna Commercial |
$3,636.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,474.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,141.41
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna Commercial |
$3,717.17
|
| Rate for Payer: Health EOS Commercial |
$3,595.96
|
| Rate for Payer: HFN Commercial |
$3,717.17
|
| Rate for Payer: Multiplan Commercial |
$3,232.32
|
| Rate for Payer: Preferred Network Access Commercial |
$3,717.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,979.80
|
| Rate for Payer: Quartz Commercial |
$2,424.24
|
| Rate for Payer: WEA Trust Commercial |
$2,222.22
|
| Rate for Payer: WPS Commercial |
$2,992.62
|
|
|
DRILL BIT STANDARD 2.0MM X 110MM AO XFO082001
|
Facility
|
IP
|
$2,763.00
|
|
| Hospital Charge Code |
5591287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,408.02 |
| Max. Negotiated Rate |
$2,643.64 |
| Rate for Payer: Aetna Commercial |
$2,586.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,471.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.97
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna Commercial |
$2,643.64
|
| Rate for Payer: Health EOS Commercial |
$2,557.43
|
| Rate for Payer: HFN Commercial |
$2,643.64
|
| Rate for Payer: Multiplan Commercial |
$2,298.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,643.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,408.02
|
| Rate for Payer: Quartz Commercial |
$1,724.11
|
| Rate for Payer: WEA Trust Commercial |
$1,580.44
|
| Rate for Payer: WPS Commercial |
$2,128.34
|
|
|
DRILL BIT STANDARD 2.0MM X 110MM AO XFO082001
|
Facility
|
OP
|
$2,763.00
|
|
| Hospital Charge Code |
5591287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.59 |
| Max. Negotiated Rate |
$2,643.64 |
| Rate for Payer: Aetna Commercial |
$2,586.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,471.23
|
| Rate for Payer: Aetna Managed Medicare |
$804.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,867.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,436.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,379.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,522.97
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna Commercial |
$2,643.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,608.07
|
| Rate for Payer: Health EOS Commercial |
$2,557.43
|
| Rate for Payer: HFN Commercial |
$2,643.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,155.14
|
| Rate for Payer: Multiplan Commercial |
$2,298.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,724.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,643.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,408.02
|
| Rate for Payer: Quartz Commercial |
$1,867.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,724.11
|
| Rate for Payer: The Alliance Commercial |
$1,436.76
|
| Rate for Payer: WEA Trust Commercial |
$1,580.44
|
| Rate for Payer: WPS Commercial |
$2,128.34
|
|
|
DRILL BIT STEPPED 4.5/6.5MM LARGE QC 03.010.078
|
Facility
|
IP
|
$3,418.00
|
|
| Hospital Charge Code |
3127488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,741.81 |
| Max. Negotiated Rate |
$3,270.34 |
| Rate for Payer: Aetna Commercial |
$3,199.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,057.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cigna Commercial |
$3,270.34
|
| Rate for Payer: Health EOS Commercial |
$3,163.70
|
| Rate for Payer: HFN Commercial |
$3,270.34
|
| Rate for Payer: Multiplan Commercial |
$2,843.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,270.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,741.81
|
| Rate for Payer: Quartz Commercial |
$2,132.83
|
| Rate for Payer: WEA Trust Commercial |
$1,955.10
|
| Rate for Payer: WPS Commercial |
$2,632.89
|
|
|
DRILL BIT STEPPED 4.5/6.5MM LARGE QC 03.010.078
|
Facility
|
OP
|
$3,418.00
|
|
| Hospital Charge Code |
3127488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.32 |
| Max. Negotiated Rate |
$3,270.34 |
| Rate for Payer: Aetna Commercial |
$3,199.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,057.06
|
| Rate for Payer: Aetna Managed Medicare |
$995.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,310.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,777.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,706.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cigna Commercial |
$3,270.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,989.28
|
| Rate for Payer: Health EOS Commercial |
$3,163.70
|
| Rate for Payer: HFN Commercial |
$3,270.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,666.04
|
| Rate for Payer: Multiplan Commercial |
$2,843.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,132.83
|
| Rate for Payer: Preferred Network Access Commercial |
$3,270.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,741.81
|
| Rate for Payer: Quartz Commercial |
$2,310.57
|
| Rate for Payer: Quartz Medicare Advantage |
$2,132.83
|
| Rate for Payer: The Alliance Commercial |
$1,777.36
|
| Rate for Payer: WEA Trust Commercial |
$1,955.10
|
| Rate for Payer: WPS Commercial |
$2,632.89
|
|
|
DRILL BIT THREADED PILOT 214-00-013
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
4508843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$921.94 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Aetna Managed Medicare |
$921.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,140.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,646.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,842.61
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,469.48
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,975.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$2,140.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,975.58
|
| Rate for Payer: The Alliance Commercial |
$1,646.32
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
