|
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
|
|
|
DRILL BIT THREADED PILOT 214-00-017
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5547270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,355.54 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,659.84
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
DRILL BIT THREADED PILOT 214-00-017
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5547270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Aetna Managed Medicare |
$774.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,327.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.12
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,074.80
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: NAPHCARE Commercial |
$1,659.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,798.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,659.84
|
| Rate for Payer: The Alliance Commercial |
$1,383.20
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
DRILL BIT TRILLIANT TIGER 3.0/4.O 210-40-001
|
Facility
|
IP
|
$3,048.00
|
|
| Hospital Charge Code |
3323483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,553.26 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$1,901.95
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
DRILL BIT TRILLIANT TIGER 3.0/4.O 210-40-001
|
Facility
|
OP
|
$3,048.00
|
|
| Hospital Charge Code |
3323483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.58 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Aetna Managed Medicare |
$887.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,060.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,584.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,521.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,773.94
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,377.44
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,901.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$2,060.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,901.95
|
| Rate for Payer: The Alliance Commercial |
$1,584.96
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
DRILL BIT TROCAR 1.5MM 100MM QC WITH 6MM STOP 317.875
|
Facility
|
IP
|
$2,783.00
|
|
| Hospital Charge Code |
6172585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,418.22 |
| Max. Negotiated Rate |
$2,662.77 |
| Rate for Payer: Aetna Commercial |
$2,604.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,489.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,533.99
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cigna Commercial |
$2,662.77
|
| Rate for Payer: Health EOS Commercial |
$2,575.94
|
| Rate for Payer: HFN Commercial |
$2,662.77
|
| Rate for Payer: Multiplan Commercial |
$2,315.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,662.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,418.22
|
| Rate for Payer: Quartz Commercial |
$1,736.59
|
| Rate for Payer: WEA Trust Commercial |
$1,591.88
|
| Rate for Payer: WPS Commercial |
$2,143.74
|
|
|
DRILL BIT TROCAR 1.5MM 100MM QC WITH 6MM STOP 317.875
|
Facility
|
OP
|
$2,783.00
|
|
| Hospital Charge Code |
6172585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.41 |
| Max. Negotiated Rate |
$2,662.77 |
| Rate for Payer: Aetna Commercial |
$2,604.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,489.12
|
| Rate for Payer: Aetna Managed Medicare |
$810.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,881.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,447.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,389.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,533.99
|
| Rate for Payer: Cash Price |
$834.90
|
| Rate for Payer: Cigna Commercial |
$2,662.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,619.71
|
| Rate for Payer: Health EOS Commercial |
$2,575.94
|
| Rate for Payer: HFN Commercial |
$2,662.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,170.74
|
| Rate for Payer: Multiplan Commercial |
$2,315.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,736.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,662.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,418.22
|
| Rate for Payer: Quartz Commercial |
$1,881.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,736.59
|
| Rate for Payer: The Alliance Commercial |
$1,447.16
|
| Rate for Payer: WEA Trust Commercial |
$1,591.88
|
| Rate for Payer: WPS Commercial |
$2,143.74
|
|
|
DRILL BIT TWIST 4.75MM SWIVELOCK AR-2276D
|
Facility
|
IP
|
$1,486.00
|
|
| Hospital Charge Code |
5591321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.27 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,390.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.08
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,421.80
|
| Rate for Payer: Health EOS Commercial |
$1,375.44
|
| Rate for Payer: HFN Commercial |
$1,421.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,421.80
|
| Rate for Payer: Quartz Beloit One Network |
$757.27
|
| Rate for Payer: Quartz Commercial |
$927.26
|
| Rate for Payer: WEA Trust Commercial |
$849.99
|
| Rate for Payer: WPS Commercial |
$1,144.67
|
|
|
DRILL BIT TWIST 4.75MM SWIVELOCK AR-2276D
|
Facility
|
OP
|
$1,486.00
|
|
| Hospital Charge Code |
5591321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.72 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,390.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.08
|
| Rate for Payer: Aetna Managed Medicare |
$432.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$772.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$741.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.08
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,421.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$864.85
|
| Rate for Payer: Health EOS Commercial |
$1,375.44
|
| Rate for Payer: HFN Commercial |
$1,421.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.08
|
| Rate for Payer: Multiplan Commercial |
$1,236.35
|
| Rate for Payer: NAPHCARE Commercial |
$927.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,421.80
|
| Rate for Payer: Quartz Beloit One Network |
$757.27
|
| Rate for Payer: Quartz Commercial |
$1,004.54
|
| Rate for Payer: Quartz Medicare Advantage |
$927.26
|
| Rate for Payer: The Alliance Commercial |
$772.72
|
| Rate for Payer: WEA Trust Commercial |
$849.99
|
| Rate for Payer: WPS Commercial |
$1,144.67
|
|
|
DRILL BIT X-FUSE MEDIAL/DISTAL STOP XFO102001
|
Facility
|
OP
|
$1,520.00
|
|
| Hospital Charge Code |
4519442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.62 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: The Alliance Commercial |
$790.40
|
| Rate for Payer: Aetna Commercial |
$1,422.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.49
|
| Rate for Payer: Aetna Managed Medicare |
$442.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,027.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$790.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$758.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.82
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$884.64
|
| Rate for Payer: Health EOS Commercial |
$1,406.91
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,185.60
|
| Rate for Payer: Multiplan Commercial |
$1,264.64
|
| Rate for Payer: NAPHCARE Commercial |
$948.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$774.59
|
| Rate for Payer: Quartz Commercial |
$1,027.52
|
| Rate for Payer: Quartz Medicare Advantage |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$869.44
|
| Rate for Payer: WPS Commercial |
$1,170.86
|
|
|
DRILL BIT X-FUSE MEDIAL/DISTAL STOP XFO102001
|
Facility
|
IP
|
$1,520.00
|
|
| Hospital Charge Code |
4519442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,422.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.82
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Health EOS Commercial |
$1,406.91
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| Rate for Payer: Multiplan Commercial |
$1,264.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$774.59
|
| Rate for Payer: Quartz Commercial |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$869.44
|
| Rate for Payer: WPS Commercial |
$1,170.86
|
|
|
DRILL BIT X-FUSE PROXIMAL 2MM XFO112001
|
Facility
|
OP
|
$1,520.00
|
|
| Hospital Charge Code |
4519441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.62 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,422.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.49
|
| Rate for Payer: Aetna Managed Medicare |
$442.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,027.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$790.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$758.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.82
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$884.64
|
| Rate for Payer: Health EOS Commercial |
$1,406.91
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,185.60
|
| Rate for Payer: Multiplan Commercial |
$1,264.64
|
| Rate for Payer: NAPHCARE Commercial |
$948.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$774.59
|
| Rate for Payer: Quartz Commercial |
$1,027.52
|
| Rate for Payer: Quartz Medicare Advantage |
$948.48
|
| Rate for Payer: The Alliance Commercial |
$790.40
|
| Rate for Payer: WEA Trust Commercial |
$869.44
|
| Rate for Payer: WPS Commercial |
$1,170.86
|
|
|
DRILL BIT X-FUSE PROXIMAL 2MM XFO112001
|
Facility
|
IP
|
$1,520.00
|
|
| Hospital Charge Code |
4519441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,422.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.82
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Health EOS Commercial |
$1,406.91
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| Rate for Payer: Multiplan Commercial |
$1,264.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$774.59
|
| Rate for Payer: Quartz Commercial |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$869.44
|
| Rate for Payer: WPS Commercial |
$1,170.86
|
|
|
DRILL CALIBRATED, 4.0MM X 280MM S0219-100
|
Facility
|
OP
|
$2,929.00
|
|
| Hospital Charge Code |
6232144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Aetna Managed Medicare |
$852.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,523.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,462.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.68
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.62
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,827.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,980.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,827.70
|
| Rate for Payer: The Alliance Commercial |
$1,523.08
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
DRILL CALIBRATED, 4.0MM X 280MM S0219-100
|
Facility
|
IP
|
$2,929.00
|
|
| Hospital Charge Code |
6232144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,492.62 |
| Max. Negotiated Rate |
$2,802.47 |
| Rate for Payer: Aetna Commercial |
$2,741.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,619.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,614.46
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,802.47
|
| Rate for Payer: Health EOS Commercial |
$2,711.08
|
| Rate for Payer: HFN Commercial |
$2,802.47
|
| Rate for Payer: Multiplan Commercial |
$2,436.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,802.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.62
|
| Rate for Payer: Quartz Commercial |
$1,827.70
|
| Rate for Payer: WEA Trust Commercial |
$1,675.39
|
| Rate for Payer: WPS Commercial |
$2,256.21
|
|
|
DRILL FLIP CUTTER III AR-1204FF
|
Facility
|
OP
|
$4,415.00
|
|
| Hospital Charge Code |
5547218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,285.65 |
| Max. Negotiated Rate |
$4,224.27 |
| Rate for Payer: Aetna Commercial |
$4,132.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,948.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,285.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,984.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,295.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,203.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,433.55
|
| Rate for Payer: Cash Price |
$1,324.50
|
| Rate for Payer: Cigna Commercial |
$4,224.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,569.53
|
| Rate for Payer: Health EOS Commercial |
$4,086.52
|
| Rate for Payer: HFN Commercial |
$4,224.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,443.70
|
| Rate for Payer: Multiplan Commercial |
$3,673.28
|
| Rate for Payer: NAPHCARE Commercial |
$2,754.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,224.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,249.88
|
| Rate for Payer: Quartz Commercial |
$2,984.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,754.96
|
| Rate for Payer: The Alliance Commercial |
$2,295.80
|
| Rate for Payer: WEA Trust Commercial |
$2,525.38
|
| Rate for Payer: WPS Commercial |
$3,400.87
|
|
|
DRILL FLIP CUTTER III AR-1204FF
|
Facility
|
IP
|
$4,415.00
|
|
| Hospital Charge Code |
5547218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,249.88 |
| Max. Negotiated Rate |
$4,224.27 |
| Rate for Payer: Aetna Commercial |
$4,132.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,948.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,433.55
|
| Rate for Payer: Cash Price |
$1,324.50
|
| Rate for Payer: Cigna Commercial |
$4,224.27
|
| Rate for Payer: Health EOS Commercial |
$4,086.52
|
| Rate for Payer: HFN Commercial |
$4,224.27
|
| Rate for Payer: Multiplan Commercial |
$3,673.28
|
| Rate for Payer: Preferred Network Access Commercial |
$4,224.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,249.88
|
| Rate for Payer: Quartz Commercial |
$2,754.96
|
| Rate for Payer: WEA Trust Commercial |
$2,525.38
|
| Rate for Payer: WPS Commercial |
$3,400.87
|
|
|
DRILL FREEHAND 4.2 X 130MM IMN 2351-4213S
|
Facility
|
OP
|
$2,764.00
|
|
| Hospital Charge Code |
5599786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.88 |
| Max. Negotiated Rate |
$2,644.60 |
| Rate for Payer: Aetna Commercial |
$2,587.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,472.12
|
| Rate for Payer: Aetna Managed Medicare |
$804.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,868.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,437.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,379.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,523.52
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$2,644.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,608.65
|
| Rate for Payer: Health EOS Commercial |
$2,558.36
|
| Rate for Payer: HFN Commercial |
$2,644.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,155.92
|
| Rate for Payer: Multiplan Commercial |
$2,299.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,724.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,644.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,408.53
|
| Rate for Payer: Quartz Commercial |
$1,868.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,724.74
|
| Rate for Payer: The Alliance Commercial |
$1,437.28
|
| Rate for Payer: WEA Trust Commercial |
$1,581.01
|
| Rate for Payer: WPS Commercial |
$2,129.11
|
|
|
DRILL FREEHAND 4.2 X 130MM IMN 2351-4213S
|
Facility
|
IP
|
$2,764.00
|
|
| Hospital Charge Code |
5599786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,408.53 |
| Max. Negotiated Rate |
$2,644.60 |
| Rate for Payer: Aetna Commercial |
$2,587.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,472.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,523.52
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$2,644.60
|
| Rate for Payer: Health EOS Commercial |
$2,558.36
|
| Rate for Payer: HFN Commercial |
$2,644.60
|
| Rate for Payer: Multiplan Commercial |
$2,299.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,644.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,408.53
|
| Rate for Payer: Quartz Commercial |
$1,724.74
|
| Rate for Payer: WEA Trust Commercial |
$1,581.01
|
| Rate for Payer: WPS Commercial |
$2,129.11
|
|
|
DRILL FREEHAND 4.2 X 185MM IMN 2351-4218S
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
6151668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.71 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
DRILL FREEHAND 4.2 X 185MM IMN 2351-4218S
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
6151668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
DRILL GUIDE 1.5MTHREADED
|
Facility
|
OP
|
$3,527.00
|
|
| Hospital Charge Code |
2966218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,027.06 |
| Max. Negotiated Rate |
$3,374.63 |
| Rate for Payer: Aetna Commercial |
$3,301.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,154.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,027.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,384.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,834.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,760.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,944.08
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,374.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,052.71
|
| Rate for Payer: Health EOS Commercial |
$3,264.59
|
| Rate for Payer: HFN Commercial |
$3,374.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,751.06
|
| Rate for Payer: Multiplan Commercial |
$2,934.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,200.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,374.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,797.36
|
| Rate for Payer: Quartz Commercial |
$2,384.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,200.85
|
| Rate for Payer: The Alliance Commercial |
$1,834.04
|
| Rate for Payer: WEA Trust Commercial |
$2,017.44
|
| Rate for Payer: WPS Commercial |
$2,716.85
|
|
|
DRILL GUIDE 1.5MTHREADED
|
Facility
|
IP
|
$3,527.00
|
|
| Hospital Charge Code |
2966218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,797.36 |
| Max. Negotiated Rate |
$3,374.63 |
| Rate for Payer: Aetna Commercial |
$3,301.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,154.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,944.08
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,374.63
|
| Rate for Payer: Health EOS Commercial |
$3,264.59
|
| Rate for Payer: HFN Commercial |
$3,374.63
|
| Rate for Payer: Multiplan Commercial |
$2,934.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,374.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,797.36
|
| Rate for Payer: Quartz Commercial |
$2,200.85
|
| Rate for Payer: WEA Trust Commercial |
$2,017.44
|
| Rate for Payer: WPS Commercial |
$2,716.85
|
|
|
DRILL GUIDE 1.8 SHORT THREAD 323.035
|
Facility
|
OP
|
$1,748.00
|
|
| Hospital Charge Code |
2966607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.02 |
| Max. Negotiated Rate |
$1,672.49 |
| Rate for Payer: Aetna Commercial |
$1,636.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,563.41
|
| Rate for Payer: Aetna Managed Medicare |
$509.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,181.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$908.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$872.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$963.50
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$1,672.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,017.34
|
| Rate for Payer: Health EOS Commercial |
$1,617.95
|
| Rate for Payer: HFN Commercial |
$1,672.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,454.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,090.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,672.49
|
| Rate for Payer: Quartz Beloit One Network |
$890.78
|
| Rate for Payer: Quartz Commercial |
$1,181.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,090.75
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: WEA Trust Commercial |
$999.86
|
| Rate for Payer: WPS Commercial |
$1,346.48
|
|
|
DRILL GUIDE 1.8 SHORT THREAD 323.035
|
Facility
|
IP
|
$1,748.00
|
|
| Hospital Charge Code |
2966607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$890.78 |
| Max. Negotiated Rate |
$1,672.49 |
| Rate for Payer: Aetna Commercial |
$1,636.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,563.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$963.50
|
| Rate for Payer: Cash Price |
$524.40
|
| Rate for Payer: Cigna Commercial |
$1,672.49
|
| Rate for Payer: Health EOS Commercial |
$1,617.95
|
| Rate for Payer: HFN Commercial |
$1,672.49
|
| Rate for Payer: Multiplan Commercial |
$1,454.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,672.49
|
| Rate for Payer: Quartz Beloit One Network |
$890.78
|
| Rate for Payer: Quartz Commercial |
$1,090.75
|
| Rate for Payer: WEA Trust Commercial |
$999.86
|
| Rate for Payer: WPS Commercial |
$1,346.48
|
|
