|
BUR DIAMOND 1.4 31-55643
|
Facility
|
OP
|
$2,105.00
|
|
| Hospital Charge Code |
2965331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$8,420.00 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Aetna Managed Medicare |
$589.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.96
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.75
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,368.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.00
|
| Rate for Payer: The Alliance Commercial |
$8,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
BUR FULL RADIUS 3.5 C9942
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
3072546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
BUR FULL RADIUS 3.5 C9942
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
3072546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
BURN DEBRIDEMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BURN DEBRIDEMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BUR OVAL 8 FLUTED 4.0MM X 13CM AR-8400OBE
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5106619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR OVAL 8 FLUTED 4.0MM X 13CM AR-8400OBE
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5106619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR OVAL 8 FLUTED 5.0MM AR-8500OBE
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5206677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR OVAL 8 FLUTED 5.0MM AR-8500OBE
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5206677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BURR 20MM 3.1MM STRAIGHT AR-300-B202
|
Facility
|
OP
|
$3,580.00
|
|
| Hospital Charge Code |
5787769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$14,320.00 |
| Rate for Payer: Aetna Commercial |
$3,222.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,078.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,002.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,327.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,718.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.40
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$3,293.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,003.37
|
| Rate for Payer: Health EOS Commercial |
$3,186.20
|
| Rate for Payer: HFN Commercial |
$3,293.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,685.00
|
| Rate for Payer: Multiplan Commercial |
$2,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,293.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.20
|
| Rate for Payer: Quartz Commercial |
$2,327.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,148.00
|
| Rate for Payer: The Alliance Commercial |
$14,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,969.00
|
| Rate for Payer: WPS Commercial |
$2,651.71
|
|
|
BURR 20MM 3.1MM STRAIGHT AR-300-B202
|
Facility
|
IP
|
$3,580.00
|
|
| Hospital Charge Code |
5787769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,754.20 |
| Max. Negotiated Rate |
$3,293.60 |
| Rate for Payer: Aetna Commercial |
$3,222.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,078.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.40
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$3,293.60
|
| Rate for Payer: Health EOS Commercial |
$3,186.20
|
| Rate for Payer: HFN Commercial |
$3,293.60
|
| Rate for Payer: Multiplan Commercial |
$2,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,293.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.20
|
| Rate for Payer: Quartz Commercial |
$2,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,969.00
|
| Rate for Payer: WPS Commercial |
$2,651.71
|
|
|
BURR CARTILAGE 2MM X 8MM CYLINDER SS 58CC2008
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
6180079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,575.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,656.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,812.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.75
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,218.75
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,656.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,375.00
|
| Rate for Payer: The Alliance Commercial |
$22,500.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
BURR CARTILAGE 2MM X 8MM CYLINDER SS 58CC2008
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
6180079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,756.25 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
BURR CORTICAL SPHERE 4MM 58RSPH40
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6199057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR CORTICAL SPHERE 4MM 58RSPH40
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6199057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BUR ROUND BUTT 4.0MM AR-8400RBE
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5206678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR ROUND BUTT 4.0MM AR-8400RBE
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5206678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
BUR ROUND DIAMOND 1.5 X 48 CRS E5215
|
Facility
|
IP
|
$1,464.00
|
|
| Hospital Charge Code |
2964869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
BUR ROUND DIAMOND 1.5 X 48 CRS E5215
|
Facility
|
OP
|
$1,464.00
|
|
| Hospital Charge Code |
2964869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
BUR ROUND DIAMOND 4 X 48 #E6240
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$851.62 |
| Max. Negotiated Rate |
$1,598.96 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,042.80
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
|
BUR ROUND DIAMOND 4 X 48 #E6240
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.64 |
| Max. Negotiated Rate |
$6,952.00 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.68
|
| Rate for Payer: Aetna Managed Medicare |
$486.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,129.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$869.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$834.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.14
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$972.58
|
| Rate for Payer: Health EOS Commercial |
$1,546.82
|
| Rate for Payer: HFN Commercial |
$1,598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,303.50
|
| Rate for Payer: Multiplan Commercial |
$1,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.96
|
| Rate for Payer: Quartz Beloit One Network |
$851.62
|
| Rate for Payer: Quartz Commercial |
$1,129.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,042.80
|
| Rate for Payer: The Alliance Commercial |
$6,952.00
|
| Rate for Payer: WEA Trust Commercial |
$955.90
|
| Rate for Payer: WPS Commercial |
$1,287.34
|
|
|
BURR SCULPTING 2 X 8MM CYLINDER 58SC2008
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6182014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 2 X 8MM CYLINDER 58SC2008
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6182014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 3 X 12MM CYLINDER 58SC3012
|
Facility
|
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6199058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
BURR SCULPTING 3 X 12MM CYLINDER 58SC3012
|
Facility
|
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6199058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
