|
DRILL TH CANNULATED RELIEF #AI-4030
|
Facility
|
IP
|
$2,670.00
|
|
| Hospital Charge Code |
2964743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,360.63 |
| Max. Negotiated Rate |
$2,554.66 |
| Rate for Payer: Aetna Commercial |
$2,499.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.70
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,554.66
|
| Rate for Payer: Health EOS Commercial |
$2,471.35
|
| Rate for Payer: HFN Commercial |
$2,554.66
|
| Rate for Payer: Multiplan Commercial |
$2,221.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.63
|
| Rate for Payer: Quartz Commercial |
$1,666.08
|
| Rate for Payer: WEA Trust Commercial |
$1,527.24
|
| Rate for Payer: WPS Commercial |
$2,056.70
|
|
|
DRILL TH CANNULATED RELIEF #AI-4030
|
Facility
|
OP
|
$2,670.00
|
|
| Hospital Charge Code |
2964743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.50 |
| Max. Negotiated Rate |
$2,554.66 |
| Rate for Payer: Aetna Commercial |
$2,499.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.05
|
| Rate for Payer: Aetna Managed Medicare |
$777.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,804.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,388.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.70
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,554.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,553.94
|
| Rate for Payer: Health EOS Commercial |
$2,471.35
|
| Rate for Payer: HFN Commercial |
$2,554.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,082.60
|
| Rate for Payer: Multiplan Commercial |
$2,221.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.63
|
| Rate for Payer: Quartz Commercial |
$1,804.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,666.08
|
| Rate for Payer: The Alliance Commercial |
$1,388.40
|
| Rate for Payer: WEA Trust Commercial |
$1,527.24
|
| Rate for Payer: WPS Commercial |
$2,056.70
|
|
|
DRILL TIP GUIDE WIRE 2.5 X 300 03.120.026
|
Facility
|
IP
|
$1,187.00
|
|
| Hospital Charge Code |
2966226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.90 |
| Max. Negotiated Rate |
$1,135.72 |
| Rate for Payer: Aetna Commercial |
$1,111.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.27
|
| Rate for Payer: Cash Price |
$356.10
|
| Rate for Payer: Cigna Commercial |
$1,135.72
|
| Rate for Payer: Health EOS Commercial |
$1,098.69
|
| Rate for Payer: HFN Commercial |
$1,135.72
|
| Rate for Payer: Multiplan Commercial |
$987.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.72
|
| Rate for Payer: Quartz Beloit One Network |
$604.90
|
| Rate for Payer: Quartz Commercial |
$740.69
|
| Rate for Payer: WEA Trust Commercial |
$678.96
|
| Rate for Payer: WPS Commercial |
$914.35
|
|
|
DRILL TIP GUIDE WIRE 2.5 X 300 03.120.026
|
Facility
|
OP
|
$1,187.00
|
|
| Hospital Charge Code |
2966226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.65 |
| Max. Negotiated Rate |
$1,135.72 |
| Rate for Payer: Aetna Commercial |
$1,111.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.65
|
| Rate for Payer: Aetna Managed Medicare |
$345.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$802.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.27
|
| Rate for Payer: Cash Price |
$356.10
|
| Rate for Payer: Cigna Commercial |
$1,135.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.83
|
| Rate for Payer: Health EOS Commercial |
$1,098.69
|
| Rate for Payer: HFN Commercial |
$1,135.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.86
|
| Rate for Payer: Multiplan Commercial |
$987.58
|
| Rate for Payer: NAPHCARE Commercial |
$740.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.72
|
| Rate for Payer: Quartz Beloit One Network |
$604.90
|
| Rate for Payer: Quartz Commercial |
$802.41
|
| Rate for Payer: Quartz Medicare Advantage |
$740.69
|
| Rate for Payer: The Alliance Commercial |
$617.24
|
| Rate for Payer: WEA Trust Commercial |
$678.96
|
| Rate for Payer: WPS Commercial |
$914.35
|
|
|
DRILL TWIST CORTICAL OPENER 3.5MM 700353
|
Facility
|
IP
|
$1,402.00
|
|
| Hospital Charge Code |
3983346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.46 |
| Max. Negotiated Rate |
$1,341.43 |
| Rate for Payer: Aetna Commercial |
$1,312.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.78
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$1,341.43
|
| Rate for Payer: Health EOS Commercial |
$1,297.69
|
| Rate for Payer: HFN Commercial |
$1,341.43
|
| Rate for Payer: Multiplan Commercial |
$1,166.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,341.43
|
| Rate for Payer: Quartz Beloit One Network |
$714.46
|
| Rate for Payer: Quartz Commercial |
$874.85
|
| Rate for Payer: WEA Trust Commercial |
$801.94
|
| Rate for Payer: WPS Commercial |
$1,079.96
|
|
|
DRILL TWIST CORTICAL OPENER 3.5MM 700353
|
Facility
|
OP
|
$1,402.00
|
|
| Hospital Charge Code |
3983346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.26 |
| Max. Negotiated Rate |
$1,341.43 |
| Rate for Payer: Aetna Commercial |
$1,312.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.95
|
| Rate for Payer: Aetna Managed Medicare |
$408.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$947.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$729.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$699.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.78
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$1,341.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$815.96
|
| Rate for Payer: Health EOS Commercial |
$1,297.69
|
| Rate for Payer: HFN Commercial |
$1,341.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,093.56
|
| Rate for Payer: Multiplan Commercial |
$1,166.46
|
| Rate for Payer: NAPHCARE Commercial |
$874.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,341.43
|
| Rate for Payer: Quartz Beloit One Network |
$714.46
|
| Rate for Payer: Quartz Commercial |
$947.75
|
| Rate for Payer: Quartz Medicare Advantage |
$874.85
|
| Rate for Payer: The Alliance Commercial |
$729.04
|
| Rate for Payer: WEA Trust Commercial |
$801.94
|
| Rate for Payer: WPS Commercial |
$1,079.96
|
|
|
DRIVER 2.6MM SPADE 214-00-016
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5496695
|
|
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
|
|
|
DRIVER 2.6MM SPADE 214-00-016
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5496695
|
|
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
|
|
|
DRIVER 3.4MM SPADE 214-00-009
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
5248638
|
|
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
|
|
|
DRIVER 3.4MM SPADE 214-00-009
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
5248638
|
|
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
|
|
|
DRIVER BIT GRIDLOCK 320-35-003
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5459735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.10 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,436.45
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
DRIVER BIT GRIDLOCK 320-35-003
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5459735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.34 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Aetna Managed Medicare |
$670.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.76
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.56
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,556.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.45
|
| Rate for Payer: The Alliance Commercial |
$1,197.04
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
DRIVER GRIDLOCK 317-24-003
|
Facility
|
OP
|
$2,585.00
|
|
| Hospital Charge Code |
5547441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.75 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$752.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,747.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,504.47
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,016.30
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,747.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.04
|
| Rate for Payer: The Alliance Commercial |
$1,344.20
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
DRIVER GRIDLOCK 317-24-003
|
Facility
|
IP
|
$2,585.00
|
|
| Hospital Charge Code |
5547441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
DRIVER HIGH TORQUE BIOMET 70-2001
|
Facility
|
IP
|
$2,055.00
|
|
| Hospital Charge Code |
5349383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,047.23 |
| Max. Negotiated Rate |
$1,966.22 |
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Aetna Commercial |
$1,923.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.72
|
| Rate for Payer: Cigna Commercial |
$1,966.22
|
| Rate for Payer: Health EOS Commercial |
$1,902.11
|
| Rate for Payer: HFN Commercial |
$1,966.22
|
| Rate for Payer: Multiplan Commercial |
$1,709.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.23
|
| Rate for Payer: Quartz Commercial |
$1,282.32
|
| Rate for Payer: WEA Trust Commercial |
$1,175.46
|
| Rate for Payer: WPS Commercial |
$1,582.97
|
|
|
DRIVER HIGH TORQUE BIOMET 70-2001
|
Facility
|
OP
|
$2,055.00
|
|
| Hospital Charge Code |
5349383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.42 |
| Max. Negotiated Rate |
$1,966.22 |
| Rate for Payer: Aetna Commercial |
$1,923.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.99
|
| Rate for Payer: Aetna Managed Medicare |
$598.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,068.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,025.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.72
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,966.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.01
|
| Rate for Payer: Health EOS Commercial |
$1,902.11
|
| Rate for Payer: HFN Commercial |
$1,966.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.90
|
| Rate for Payer: Multiplan Commercial |
$1,709.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.23
|
| Rate for Payer: Quartz Commercial |
$1,389.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.32
|
| Rate for Payer: The Alliance Commercial |
$1,068.60
|
| Rate for Payer: WEA Trust Commercial |
$1,175.46
|
| Rate for Payer: WPS Commercial |
$1,582.97
|
|
|
DRIVER MSP T6 MS-DR
|
Facility
|
OP
|
$2,855.00
|
|
| Hospital Charge Code |
5510698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.38 |
| Max. Negotiated Rate |
$2,731.66 |
| Rate for Payer: Aetna Commercial |
$2,672.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,553.51
|
| Rate for Payer: Aetna Managed Medicare |
$831.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,929.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,484.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,425.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.68
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$2,731.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,661.61
|
| Rate for Payer: Health EOS Commercial |
$2,642.59
|
| Rate for Payer: HFN Commercial |
$2,731.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,226.90
|
| Rate for Payer: Multiplan Commercial |
$2,375.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,781.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,731.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.91
|
| Rate for Payer: Quartz Commercial |
$1,929.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,781.52
|
| Rate for Payer: The Alliance Commercial |
$1,484.60
|
| Rate for Payer: WEA Trust Commercial |
$1,633.06
|
| Rate for Payer: WPS Commercial |
$2,199.21
|
|
|
DRIVER MSP T6 MS-DR
|
Facility
|
IP
|
$2,855.00
|
|
| Hospital Charge Code |
5510698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,454.91 |
| Max. Negotiated Rate |
$2,731.66 |
| Rate for Payer: Aetna Commercial |
$2,672.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,553.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.68
|
| Rate for Payer: Cash Price |
$856.50
|
| Rate for Payer: Cigna Commercial |
$2,731.66
|
| Rate for Payer: Health EOS Commercial |
$2,642.59
|
| Rate for Payer: HFN Commercial |
$2,731.66
|
| Rate for Payer: Multiplan Commercial |
$2,375.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,731.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.91
|
| Rate for Payer: Quartz Commercial |
$1,781.52
|
| Rate for Payer: WEA Trust Commercial |
$1,633.06
|
| Rate for Payer: WPS Commercial |
$2,199.21
|
|
|
DRIVER T8 (2.5MM SCREWS) IS1106
|
Facility
|
IP
|
$2,584.00
|
|
| Hospital Charge Code |
5861646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.81 |
| Max. Negotiated Rate |
$2,472.37 |
| Rate for Payer: Aetna Commercial |
$2,418.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.30
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,472.37
|
| Rate for Payer: Health EOS Commercial |
$2,391.75
|
| Rate for Payer: HFN Commercial |
$2,472.37
|
| Rate for Payer: Multiplan Commercial |
$2,149.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.81
|
| Rate for Payer: Quartz Commercial |
$1,612.42
|
| Rate for Payer: WEA Trust Commercial |
$1,478.05
|
| Rate for Payer: WPS Commercial |
$1,990.46
|
|
|
DRIVER T8 (2.5MM SCREWS) IS1106
|
Facility
|
OP
|
$2,584.00
|
|
| Hospital Charge Code |
5861646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.46 |
| Max. Negotiated Rate |
$2,472.37 |
| Rate for Payer: Aetna Commercial |
$2,418.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.13
|
| Rate for Payer: Aetna Managed Medicare |
$752.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.30
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,472.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.89
|
| Rate for Payer: Health EOS Commercial |
$2,391.75
|
| Rate for Payer: HFN Commercial |
$2,472.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.52
|
| Rate for Payer: Multiplan Commercial |
$2,149.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.81
|
| Rate for Payer: Quartz Commercial |
$1,746.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.42
|
| Rate for Payer: The Alliance Commercial |
$1,343.68
|
| Rate for Payer: WEA Trust Commercial |
$1,478.05
|
| Rate for Payer: WPS Commercial |
$1,990.46
|
|
|
DRIVER T9 (3.0MM SCREWS) IS1107
|
Facility
|
OP
|
$2,584.00
|
|
| Hospital Charge Code |
5831691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.46 |
| Max. Negotiated Rate |
$2,472.37 |
| Rate for Payer: Aetna Commercial |
$2,418.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.13
|
| Rate for Payer: Aetna Managed Medicare |
$752.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.30
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,472.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.89
|
| Rate for Payer: Health EOS Commercial |
$2,391.75
|
| Rate for Payer: HFN Commercial |
$2,472.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.52
|
| Rate for Payer: Multiplan Commercial |
$2,149.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.81
|
| Rate for Payer: Quartz Commercial |
$1,746.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.42
|
| Rate for Payer: The Alliance Commercial |
$1,343.68
|
| Rate for Payer: WEA Trust Commercial |
$1,478.05
|
| Rate for Payer: WPS Commercial |
$1,990.46
|
|
|
DRIVER T9 (3.0MM SCREWS) IS1107
|
Facility
|
IP
|
$2,584.00
|
|
| Hospital Charge Code |
5831691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.81 |
| Max. Negotiated Rate |
$2,472.37 |
| Rate for Payer: Aetna Commercial |
$2,418.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.30
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,472.37
|
| Rate for Payer: Health EOS Commercial |
$2,391.75
|
| Rate for Payer: HFN Commercial |
$2,472.37
|
| Rate for Payer: Multiplan Commercial |
$2,149.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.81
|
| Rate for Payer: Quartz Commercial |
$1,612.42
|
| Rate for Payer: WEA Trust Commercial |
$1,478.05
|
| Rate for Payer: WPS Commercial |
$1,990.46
|
|
|
DRIVER TIP 2.5MM CANNULATED ACUTRAK HT-1725
|
Facility
|
IP
|
$3,021.00
|
|
| Hospital Charge Code |
4206005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,539.50 |
| Max. Negotiated Rate |
$2,890.49 |
| Rate for Payer: Aetna Commercial |
$2,827.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,701.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,665.18
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,890.49
|
| Rate for Payer: Health EOS Commercial |
$2,796.24
|
| Rate for Payer: HFN Commercial |
$2,890.49
|
| Rate for Payer: Multiplan Commercial |
$2,513.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,890.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,539.50
|
| Rate for Payer: Quartz Commercial |
$1,885.10
|
| Rate for Payer: WEA Trust Commercial |
$1,728.01
|
| Rate for Payer: WPS Commercial |
$2,327.08
|
|
|
DRIVER TIP 2.5MM CANNULATED ACUTRAK HT-1725
|
Facility
|
OP
|
$3,021.00
|
|
| Hospital Charge Code |
4206005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.72 |
| Max. Negotiated Rate |
$2,890.49 |
| Rate for Payer: Aetna Commercial |
$2,827.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,701.98
|
| Rate for Payer: Aetna Managed Medicare |
$879.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,042.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,570.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,508.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,665.18
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,890.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,758.22
|
| Rate for Payer: Health EOS Commercial |
$2,796.24
|
| Rate for Payer: HFN Commercial |
$2,890.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,356.38
|
| Rate for Payer: Multiplan Commercial |
$2,513.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,885.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,890.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,539.50
|
| Rate for Payer: Quartz Commercial |
$2,042.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,885.10
|
| Rate for Payer: The Alliance Commercial |
$1,570.92
|
| Rate for Payer: WEA Trust Commercial |
$1,728.01
|
| Rate for Payer: WPS Commercial |
$2,327.08
|
|
|
DRIVER TIP CANNULATED ACUTRAK 2 HT-1120
|
Facility
|
OP
|
$3,086.00
|
|
| Hospital Charge Code |
3901368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.64 |
| Max. Negotiated Rate |
$2,952.68 |
| Rate for Payer: Aetna Commercial |
$2,888.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,760.12
|
| Rate for Payer: Aetna Managed Medicare |
$898.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,086.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,604.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,540.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,701.00
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,952.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,796.05
|
| Rate for Payer: Health EOS Commercial |
$2,856.40
|
| Rate for Payer: HFN Commercial |
$2,952.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,407.08
|
| Rate for Payer: Multiplan Commercial |
$2,567.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,925.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,952.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,572.63
|
| Rate for Payer: Quartz Commercial |
$2,086.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,925.66
|
| Rate for Payer: The Alliance Commercial |
$1,604.72
|
| Rate for Payer: WEA Trust Commercial |
$1,765.19
|
| Rate for Payer: WPS Commercial |
$2,377.15
|
|
