|
DRESSING V.A.C. VERAFLO CLEANSE CHOICE MEDIUM ULTVCC05MD
|
Facility
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS A6550
|
| Hospital Charge Code |
5583409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$1,620.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$954.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,656.00
|
| Rate for Payer: Health EOS Commercial |
$1,602.00
|
| Rate for Payer: HFN Commercial |
$1,656.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,080.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,656.00
|
| Rate for Payer: Quartz Beloit One Network |
$882.00
|
| Rate for Payer: Quartz Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$990.00
|
| Rate for Payer: WPS Commercial |
$1,333.26
|
|
|
DRESSING V.A.C. VERAFLO CLEANSE CHOICE MEDIUM ULTVCC05MD
|
Facility
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS A6550
|
| Hospital Charge Code |
5583409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$1,620.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.00
|
| Rate for Payer: Aetna Managed Medicare |
$504.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,170.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$900.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$864.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$954.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,656.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,007.28
|
| Rate for Payer: Health EOS Commercial |
$1,602.00
|
| Rate for Payer: HFN Commercial |
$1,656.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,080.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,656.00
|
| Rate for Payer: Quartz Beloit One Network |
$882.00
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$990.00
|
| Rate for Payer: WPS Commercial |
$1,333.26
|
|
|
Dressing Vaseline
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
3040320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Dressing Vaseline
|
Facility
IP
|
$1.00
|
|
| Hospital Charge Code |
3040320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
DRESSING VASELINE GAUZE 1X8 8884417601
|
Facility
IP
|
$20.00
|
|
| Hospital Charge Code |
2963746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
DRESSING VASELINE GAUZE 1X8 8884417601
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
2963746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.19
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
DRESSING VASELINE GAUZE 3X9
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
HCPCS A6223
|
| Hospital Charge Code |
2963775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
DRESSING VASELINE GAUZE 3X9
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
HCPCS A6223
|
| Hospital Charge Code |
2963775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
DRESSING XEROFORM 1 X 8 IN OCCLUSICE GAUZE STRIP 8884433301
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
HCPCS A6222
|
| Hospital Charge Code |
2963792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
DRESSING XEROFORM 1 X 8 IN OCCLUSICE GAUZE STRIP 8884433301
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
HCPCS A6222
|
| Hospital Charge Code |
2963792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
DRESSING XEROFORM 2X2
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
HCPCS A6222
|
| Hospital Charge Code |
2974367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
DRESSING XEROFORM 2X2
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
HCPCS A6222
|
| Hospital Charge Code |
2974367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
DRESSING XEROFORM 5x9 IN 8884433605/CUR253590
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
HCPCS A6223
|
| Hospital Charge Code |
2963703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
DRESSING XEROFORM 5x9 IN 8884433605/CUR253590
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
HCPCS A6223
|
| Hospital Charge Code |
2963703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.50
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Quartz Medicare Advantage |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
DRILL 1.1 MINI QC 310.111
|
Facility
OP
|
$1,275.00
|
|
| Hospital Charge Code |
2966169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$5,100.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.50
|
| Rate for Payer: Aetna Managed Medicare |
$357.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.75
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$713.49
|
| Rate for Payer: Health EOS Commercial |
$1,134.75
|
| Rate for Payer: HFN Commercial |
$1,173.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$956.25
|
| Rate for Payer: Multiplan Commercial |
$1,020.00
|
| Rate for Payer: NAPHCARE Commercial |
$765.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.00
|
| Rate for Payer: Quartz Beloit One Network |
$624.75
|
| Rate for Payer: Quartz Commercial |
$828.75
|
| Rate for Payer: Quartz Medicare Advantage |
$765.00
|
| Rate for Payer: The Alliance Commercial |
$5,100.00
|
| Rate for Payer: WEA Trust Commercial |
$701.25
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
DRILL 1.1 MINI QC 310.111
|
Facility
IP
|
$1,275.00
|
|
| Hospital Charge Code |
2966169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.75 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.75
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: Health EOS Commercial |
$1,134.75
|
| Rate for Payer: HFN Commercial |
$1,173.00
|
| Rate for Payer: Multiplan Commercial |
$1,020.00
|
| Rate for Payer: NAPHCARE Commercial |
$765.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.00
|
| Rate for Payer: Quartz Beloit One Network |
$624.75
|
| Rate for Payer: Quartz Commercial |
$765.00
|
| Rate for Payer: WEA Trust Commercial |
$701.25
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
DRILL 1X48 DIAMOND E5210
|
Facility
IP
|
$1,464.00
|
|
| Hospital Charge Code |
2964912
|
|
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: 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
|
|
|
DRILL 1X48 DIAMOND E5210
|
Facility
OP
|
$1,464.00
|
|
| Hospital Charge Code |
2964912
|
|
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
|
|
|
DRILL 2.0/2.4 OSTEOMED 316-0105
|
Facility
OP
|
$2,943.00
|
|
| Hospital Charge Code |
2969472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.04 |
| Max. Negotiated Rate |
$11,772.00 |
| Rate for Payer: Aetna Commercial |
$2,648.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,530.98
|
| Rate for Payer: Aetna Managed Medicare |
$824.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,912.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,471.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,412.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.79
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna Commercial |
$2,707.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,646.90
|
| Rate for Payer: Health EOS Commercial |
$2,619.27
|
| Rate for Payer: HFN Commercial |
$2,707.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,207.25
|
| Rate for Payer: Multiplan Commercial |
$2,354.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,765.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,707.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.07
|
| Rate for Payer: Quartz Commercial |
$1,912.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,765.80
|
| Rate for Payer: The Alliance Commercial |
$11,772.00
|
| Rate for Payer: WEA Trust Commercial |
$1,618.65
|
| Rate for Payer: WPS Commercial |
$2,179.88
|
|
|
DRILL 2.0/2.4 OSTEOMED 316-0105
|
Facility
IP
|
$2,943.00
|
|
| Hospital Charge Code |
2969472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,442.07 |
| Max. Negotiated Rate |
$2,707.56 |
| Rate for Payer: Aetna Commercial |
$2,648.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.79
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna Commercial |
$2,707.56
|
| Rate for Payer: Health EOS Commercial |
$2,619.27
|
| Rate for Payer: HFN Commercial |
$2,707.56
|
| Rate for Payer: Multiplan Commercial |
$2,354.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,765.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,707.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.07
|
| Rate for Payer: Quartz Commercial |
$1,765.80
|
| Rate for Payer: WEA Trust Commercial |
$1,618.65
|
| Rate for Payer: WPS Commercial |
$2,179.88
|
|
|
DRILL 2.0 ACUMED
|
Facility
IP
|
$1,025.00
|
|
| Hospital Charge Code |
2964135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$943.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$615.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
DRILL 2.0 ACUMED
|
Facility
OP
|
$1,025.00
|
|
| Hospital Charge Code |
2964135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$287.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.59
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$666.25
|
| Rate for Payer: Quartz Medicare Advantage |
$615.00
|
| Rate for Payer: The Alliance Commercial |
$4,100.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
DRILL 2X48 DIAMOND E5220
|
Facility
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964913
|
|
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
|
|
|
DRILL 2X48 DIAMOND E5220
|
Facility
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964913
|
|
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: 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
|
|
|
DRILL 4 X 38 ROUND CARBIDE #E8140LSO
|
Facility
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.98 |
| Max. Negotiated Rate |
$1,473.84 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$961.20
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
