|
DRILL GUIDE 2.5/1.7MM AR-8916-23
|
Facility
|
OP
|
$4,404.00
|
|
| Hospital Charge Code |
5599763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,282.44 |
| Max. Negotiated Rate |
$4,213.75 |
| Rate for Payer: Aetna Commercial |
$4,122.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,282.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,977.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,290.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,198.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,427.48
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,213.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,563.13
|
| Rate for Payer: Health EOS Commercial |
$4,076.34
|
| Rate for Payer: HFN Commercial |
$4,213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,435.12
|
| Rate for Payer: Multiplan Commercial |
$3,664.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,748.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,213.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,244.28
|
| Rate for Payer: Quartz Commercial |
$2,977.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,748.10
|
| Rate for Payer: The Alliance Commercial |
$2,290.08
|
| Rate for Payer: WEA Trust Commercial |
$2,519.09
|
| Rate for Payer: WPS Commercial |
$3,392.40
|
|
|
DRILL GUIDE 2.5/1.7MM AR-8916-23
|
Facility
|
IP
|
$4,404.00
|
|
| Hospital Charge Code |
5599763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,244.28 |
| Max. Negotiated Rate |
$4,213.75 |
| Rate for Payer: Aetna Commercial |
$4,122.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,427.48
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,213.75
|
| Rate for Payer: Health EOS Commercial |
$4,076.34
|
| Rate for Payer: HFN Commercial |
$4,213.75
|
| Rate for Payer: Multiplan Commercial |
$3,664.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,213.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,244.28
|
| Rate for Payer: Quartz Commercial |
$2,748.10
|
| Rate for Payer: WEA Trust Commercial |
$2,519.09
|
| Rate for Payer: WPS Commercial |
$3,392.40
|
|
|
DRILL GUIDE INTERFRAF M.I.B. 317-00-005
|
Facility
|
OP
|
$2,516.00
|
|
| Hospital Charge Code |
5506863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.66 |
| Max. Negotiated Rate |
$2,407.31 |
| Rate for Payer: Aetna Commercial |
$2,354.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Aetna Managed Medicare |
$732.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,700.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,308.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.82
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,407.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,464.31
|
| Rate for Payer: Health EOS Commercial |
$2,328.81
|
| Rate for Payer: HFN Commercial |
$2,407.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,962.48
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,407.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.15
|
| Rate for Payer: Quartz Commercial |
$1,700.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,569.98
|
| Rate for Payer: The Alliance Commercial |
$1,308.32
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,938.07
|
|
|
DRILL GUIDE INTERFRAF M.I.B. 317-00-005
|
Facility
|
IP
|
$2,516.00
|
|
| Hospital Charge Code |
5506863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,282.15 |
| Max. Negotiated Rate |
$2,407.31 |
| Rate for Payer: Aetna Commercial |
$2,354.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.82
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,407.31
|
| Rate for Payer: Health EOS Commercial |
$2,328.81
|
| Rate for Payer: HFN Commercial |
$2,407.31
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,407.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.15
|
| Rate for Payer: Quartz Commercial |
$1,569.98
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,938.07
|
|
|
DRILL GUIDE PULL REDUCTION DEVICE 4.3 PERC 03.120.023
|
Facility
|
IP
|
$4,804.00
|
|
| Hospital Charge Code |
3072544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,448.12 |
| Max. Negotiated Rate |
$4,596.47 |
| Rate for Payer: Aetna Commercial |
$4,496.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.96
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$4,596.47
|
| Rate for Payer: Health EOS Commercial |
$4,446.58
|
| Rate for Payer: HFN Commercial |
$4,596.47
|
| Rate for Payer: Multiplan Commercial |
$3,996.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,596.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.12
|
| Rate for Payer: Quartz Commercial |
$2,997.70
|
| Rate for Payer: WEA Trust Commercial |
$2,747.89
|
| Rate for Payer: WPS Commercial |
$3,700.52
|
|
|
DRILL GUIDE PULL REDUCTION DEVICE 4.3 PERC 03.120.023
|
Facility
|
OP
|
$4,804.00
|
|
| Hospital Charge Code |
3072544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,398.92 |
| Max. Negotiated Rate |
$4,596.47 |
| Rate for Payer: Aetna Commercial |
$4,496.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,296.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,247.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,498.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,398.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.96
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$4,596.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.93
|
| Rate for Payer: Health EOS Commercial |
$4,446.58
|
| Rate for Payer: HFN Commercial |
$4,596.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,747.12
|
| Rate for Payer: Multiplan Commercial |
$3,996.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,596.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.12
|
| Rate for Payer: Quartz Commercial |
$3,247.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.70
|
| Rate for Payer: The Alliance Commercial |
$2,498.08
|
| Rate for Payer: WEA Trust Commercial |
$2,747.89
|
| Rate for Payer: WPS Commercial |
$3,700.52
|
|
|
DRILL GUIDE THREADED M.I.B. 317-00-004
|
Facility
|
IP
|
$2,516.00
|
|
| Hospital Charge Code |
5506861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,282.15 |
| Max. Negotiated Rate |
$2,407.31 |
| Rate for Payer: Aetna Commercial |
$2,354.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.82
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,407.31
|
| Rate for Payer: Health EOS Commercial |
$2,328.81
|
| Rate for Payer: HFN Commercial |
$2,407.31
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,407.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.15
|
| Rate for Payer: Quartz Commercial |
$1,569.98
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,938.07
|
|
|
DRILL GUIDE THREADED M.I.B. 317-00-004
|
Facility
|
OP
|
$2,516.00
|
|
| Hospital Charge Code |
5506861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.66 |
| Max. Negotiated Rate |
$2,407.31 |
| Rate for Payer: Aetna Commercial |
$2,354.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Aetna Managed Medicare |
$732.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,700.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,308.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.82
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,407.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,464.31
|
| Rate for Payer: Health EOS Commercial |
$2,328.81
|
| Rate for Payer: HFN Commercial |
$2,407.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,962.48
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,407.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.15
|
| Rate for Payer: Quartz Commercial |
$1,700.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,569.98
|
| Rate for Payer: The Alliance Commercial |
$1,308.32
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,938.07
|
|
|
DRILL KIT ERGO GPS 3.2MM STERILE 531-55-88
|
Facility
|
IP
|
$2,500.70
|
|
| Hospital Charge Code |
6248149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,274.36 |
| Max. Negotiated Rate |
$2,392.67 |
| Rate for Payer: Aetna Commercial |
$2,340.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,236.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,378.39
|
| Rate for Payer: Cash Price |
$750.21
|
| Rate for Payer: Cigna Commercial |
$2,392.67
|
| Rate for Payer: Health EOS Commercial |
$2,314.65
|
| Rate for Payer: HFN Commercial |
$2,392.67
|
| Rate for Payer: Multiplan Commercial |
$2,080.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,392.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.36
|
| Rate for Payer: Quartz Commercial |
$1,560.44
|
| Rate for Payer: WEA Trust Commercial |
$1,430.40
|
| Rate for Payer: WPS Commercial |
$1,926.29
|
|
|
DRILL KIT ERGO GPS 3.2MM STERILE 531-55-88
|
Facility
|
OP
|
$2,500.70
|
|
| Hospital Charge Code |
6248149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.20 |
| Max. Negotiated Rate |
$2,392.67 |
| Rate for Payer: Aetna Commercial |
$2,340.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,236.63
|
| Rate for Payer: Aetna Managed Medicare |
$728.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,690.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,300.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,248.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,378.39
|
| Rate for Payer: Cash Price |
$750.21
|
| Rate for Payer: Cigna Commercial |
$2,392.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,455.41
|
| Rate for Payer: Health EOS Commercial |
$2,314.65
|
| Rate for Payer: HFN Commercial |
$2,392.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,950.55
|
| Rate for Payer: Multiplan Commercial |
$2,080.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,560.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,392.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.36
|
| Rate for Payer: Quartz Commercial |
$1,690.47
|
| Rate for Payer: Quartz Medicare Advantage |
$1,560.44
|
| Rate for Payer: The Alliance Commercial |
$1,300.36
|
| Rate for Payer: WEA Trust Commercial |
$1,430.40
|
| Rate for Payer: WPS Commercial |
$1,926.29
|
|
|
DRILL LOCKING 4.2 X 360MM IMN 2351-4236S
|
Facility
|
IP
|
$3,030.00
|
|
| Hospital Charge Code |
5599784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,544.09 |
| Max. Negotiated Rate |
$2,899.10 |
| Rate for Payer: Aetna Commercial |
$2,836.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.14
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,899.10
|
| Rate for Payer: Health EOS Commercial |
$2,804.57
|
| Rate for Payer: HFN Commercial |
$2,899.10
|
| Rate for Payer: Multiplan Commercial |
$2,520.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,899.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.09
|
| Rate for Payer: Quartz Commercial |
$1,890.72
|
| Rate for Payer: WEA Trust Commercial |
$1,733.16
|
| Rate for Payer: WPS Commercial |
$2,334.01
|
|
|
DRILL LOCKING 4.2 X 360MM IMN 2351-4236S
|
Facility
|
OP
|
$3,030.00
|
|
| Hospital Charge Code |
5599784
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.34 |
| Max. Negotiated Rate |
$2,899.10 |
| Rate for Payer: Aetna Commercial |
$2,836.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.03
|
| Rate for Payer: Aetna Managed Medicare |
$882.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,048.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,575.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,512.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.14
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,899.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,763.46
|
| Rate for Payer: Health EOS Commercial |
$2,804.57
|
| Rate for Payer: HFN Commercial |
$2,899.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,363.40
|
| Rate for Payer: Multiplan Commercial |
$2,520.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,890.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,899.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.09
|
| Rate for Payer: Quartz Commercial |
$2,048.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,890.72
|
| Rate for Payer: The Alliance Commercial |
$1,575.60
|
| Rate for Payer: WEA Trust Commercial |
$1,733.16
|
| Rate for Payer: WPS Commercial |
$2,334.01
|
|
|
DRILL LONG MINI
|
Facility
|
IP
|
$2,758.00
|
|
| Hospital Charge Code |
2967894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,405.48 |
| Max. Negotiated Rate |
$2,638.85 |
| Rate for Payer: Aetna Commercial |
$2,581.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.21
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,638.85
|
| Rate for Payer: Health EOS Commercial |
$2,552.80
|
| Rate for Payer: HFN Commercial |
$2,638.85
|
| Rate for Payer: Multiplan Commercial |
$2,294.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.48
|
| Rate for Payer: Quartz Commercial |
$1,720.99
|
| Rate for Payer: WEA Trust Commercial |
$1,577.58
|
| Rate for Payer: WPS Commercial |
$2,124.49
|
|
|
DRILL LONG MINI
|
Facility
|
OP
|
$2,758.00
|
|
| Hospital Charge Code |
2967894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$803.13 |
| Max. Negotiated Rate |
$2,638.85 |
| Rate for Payer: Aetna Commercial |
$2,581.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.76
|
| Rate for Payer: Aetna Managed Medicare |
$803.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,376.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.21
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cigna Commercial |
$2,638.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,605.16
|
| Rate for Payer: Health EOS Commercial |
$2,552.80
|
| Rate for Payer: HFN Commercial |
$2,638.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,151.24
|
| Rate for Payer: Multiplan Commercial |
$2,294.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,720.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.48
|
| Rate for Payer: Quartz Commercial |
$1,864.41
|
| Rate for Payer: Quartz Medicare Advantage |
$1,720.99
|
| Rate for Payer: The Alliance Commercial |
$1,434.16
|
| Rate for Payer: WEA Trust Commercial |
$1,577.58
|
| Rate for Payer: WPS Commercial |
$2,124.49
|
|
|
DRILL MICRO ACUTRAK 2 AT2-1509
|
Facility
|
IP
|
$3,386.00
|
|
| Hospital Charge Code |
2964141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
DRILL MICRO ACUTRAK 2 AT2-1509
|
Facility
|
OP
|
$3,386.00
|
|
| Hospital Charge Code |
2964141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$986.00 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,288.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,760.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,690.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$1,760.72
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
DRILL MICRO EXTENDED LONG ACUTRAK 2 80-1522
|
Facility
|
IP
|
$4,521.00
|
|
| Hospital Charge Code |
5603708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,303.90 |
| Max. Negotiated Rate |
$4,325.69 |
| Rate for Payer: Aetna Commercial |
$4,231.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,043.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,491.98
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,325.69
|
| Rate for Payer: Health EOS Commercial |
$4,184.64
|
| Rate for Payer: HFN Commercial |
$4,325.69
|
| Rate for Payer: Multiplan Commercial |
$3,761.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,325.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,303.90
|
| Rate for Payer: Quartz Commercial |
$2,821.10
|
| Rate for Payer: WEA Trust Commercial |
$2,586.01
|
| Rate for Payer: WPS Commercial |
$3,482.53
|
|
|
DRILL MICRO EXTENDED LONG ACUTRAK 2 80-1522
|
Facility
|
OP
|
$4,521.00
|
|
| Hospital Charge Code |
5603708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.52 |
| Max. Negotiated Rate |
$4,325.69 |
| Rate for Payer: Aetna Commercial |
$4,231.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,043.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,316.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,056.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,350.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,256.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,491.98
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,325.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,631.22
|
| Rate for Payer: Health EOS Commercial |
$4,184.64
|
| Rate for Payer: HFN Commercial |
$4,325.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,526.38
|
| Rate for Payer: Multiplan Commercial |
$3,761.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,325.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,303.90
|
| Rate for Payer: Quartz Commercial |
$3,056.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,821.10
|
| Rate for Payer: The Alliance Commercial |
$2,350.92
|
| Rate for Payer: WEA Trust Commercial |
$2,586.01
|
| Rate for Payer: WPS Commercial |
$3,482.53
|
|
|
DRILL MICRO LONG
|
Facility
|
OP
|
$5,950.00
|
|
| Hospital Charge Code |
2967891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,732.64 |
| Max. Negotiated Rate |
$5,692.96 |
| Rate for Payer: Aetna Commercial |
$5,569.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,321.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,732.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,022.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,094.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,970.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,279.64
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$5,692.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,462.90
|
| Rate for Payer: Health EOS Commercial |
$5,507.32
|
| Rate for Payer: HFN Commercial |
$5,692.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,641.00
|
| Rate for Payer: Multiplan Commercial |
$4,950.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,692.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,032.12
|
| Rate for Payer: Quartz Commercial |
$4,022.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,712.80
|
| Rate for Payer: The Alliance Commercial |
$3,094.00
|
| Rate for Payer: WEA Trust Commercial |
$3,403.40
|
| Rate for Payer: WPS Commercial |
$4,583.28
|
|
|
DRILL MICRO LONG
|
Facility
|
IP
|
$5,950.00
|
|
| Hospital Charge Code |
2967891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,032.12 |
| Max. Negotiated Rate |
$5,692.96 |
| Rate for Payer: Aetna Commercial |
$5,569.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,321.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,279.64
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$5,692.96
|
| Rate for Payer: Health EOS Commercial |
$5,507.32
|
| Rate for Payer: HFN Commercial |
$5,692.96
|
| Rate for Payer: Multiplan Commercial |
$4,950.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,692.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,032.12
|
| Rate for Payer: Quartz Commercial |
$3,712.80
|
| Rate for Payer: WEA Trust Commercial |
$3,403.40
|
| Rate for Payer: WPS Commercial |
$4,583.28
|
|
|
DRILL MINI PROFILE
|
Facility
|
OP
|
$2,733.00
|
|
| Hospital Charge Code |
2964142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.85 |
| Max. Negotiated Rate |
$2,614.93 |
| Rate for Payer: Aetna Commercial |
$2,558.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,444.40
|
| Rate for Payer: Aetna Managed Medicare |
$795.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,847.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,421.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,364.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,506.43
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna Commercial |
$2,614.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,590.61
|
| Rate for Payer: Health EOS Commercial |
$2,529.66
|
| Rate for Payer: HFN Commercial |
$2,614.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,131.74
|
| Rate for Payer: Multiplan Commercial |
$2,273.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,705.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,614.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,392.74
|
| Rate for Payer: Quartz Commercial |
$1,847.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,705.39
|
| Rate for Payer: The Alliance Commercial |
$1,421.16
|
| Rate for Payer: WEA Trust Commercial |
$1,563.28
|
| Rate for Payer: WPS Commercial |
$2,105.23
|
|
|
DRILL MINI PROFILE
|
Facility
|
IP
|
$2,733.00
|
|
| Hospital Charge Code |
2964142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,392.74 |
| Max. Negotiated Rate |
$2,614.93 |
| Rate for Payer: Aetna Commercial |
$2,558.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,444.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,506.43
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna Commercial |
$2,614.93
|
| Rate for Payer: Health EOS Commercial |
$2,529.66
|
| Rate for Payer: HFN Commercial |
$2,614.93
|
| Rate for Payer: Multiplan Commercial |
$2,273.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,614.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,392.74
|
| Rate for Payer: Quartz Commercial |
$1,705.39
|
| Rate for Payer: WEA Trust Commercial |
$1,563.28
|
| Rate for Payer: WPS Commercial |
$2,105.23
|
|
|
DRILL PILOT 2.0 510-20-002
|
Facility
|
OP
|
$2,394.00
|
|
| Hospital Charge Code |
5563330
|
|
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 PILOT 2.0 510-20-002
|
Facility
|
IP
|
$2,394.00
|
|
| Hospital Charge Code |
5563330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,219.98 |
| Max. Negotiated Rate |
$2,290.58 |
| Rate for Payer: Cash Price |
$718.20
|
| 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: 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 PIN BICEPS BUTTON 3.2MM AR-2263
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,076.28 |
| Max. Negotiated Rate |
$2,020.76 |
| Rate for Payer: Aetna Commercial |
$1,976.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.13
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,020.76
|
| Rate for Payer: Health EOS Commercial |
$1,954.87
|
| Rate for Payer: HFN Commercial |
$2,020.76
|
| Rate for Payer: Multiplan Commercial |
$1,757.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.28
|
| Rate for Payer: Quartz Commercial |
$1,317.89
|
| Rate for Payer: WEA Trust Commercial |
$1,208.06
|
| Rate for Payer: WPS Commercial |
$1,626.87
|
|
