|
DIAMOND BUR 5MM
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND BUR 5MM
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND BUR 6MM
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2974041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND BUR 6MM
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2974041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20D
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3613497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20D
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3613497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20DL
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20DL
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 3MM BALL D 75BA30DL
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
4519596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 3MM BALL D 75BA30DL
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
4519596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL 75BA40D
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL 75BA40D
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL D 75BA40DL
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL D 75BA40DL
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 5MM BALL 75BA50D
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 5MM BALL 75BA50D
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIANEAL 1.5% 2L LOW CALCIUM #5B9766
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
2971653
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$114.82
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
DIANEAL 1.5% 2L LOW CALCIUM #5B9766
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
2971653
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dianeal 2L 1.5% Ultrabag, Low
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS A4722
|
| Hospital Charge Code |
3603556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$114.82
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dianeal 2L 1.5% Ultrabag, Low
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS A4722
|
| Hospital Charge Code |
3603556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dianeal 2L 2.5% Ultrabag, Low
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS A4722
|
| Hospital Charge Code |
3603555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$114.82
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dianeal 2L 2.5% Ultrabag, Low
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS A4722
|
| Hospital Charge Code |
3603555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dianeal 2L 4.25% Ultrabag, Low
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS A4722
|
| Hospital Charge Code |
3603557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dianeal 2L 4.25% Ultrabag, Low
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS A4722
|
| Hospital Charge Code |
3603557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$114.82
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
DIAPERS PREM 3-6 LB INFANT 04261
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963729
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
