|
DRESSING V.A.C. WHITEFOAM SMALL 10 X 7.5 X 1CM M6275033/10
|
Facility
|
IP
|
$272.00
|
|
| Hospital Charge Code |
2974084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Dressing Vaseline
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Dressing Vaseline
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
DRESSING VASELINE GAUZE 1X8 8884417601
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
2963746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.64
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: NAPHCARE Commercial |
$12.48
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$13.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12.48
|
| Rate for Payer: The Alliance Commercial |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$15.41
|
|
|
DRESSING VASELINE GAUZE 1X8 8884417601
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
2963746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$15.41
|
|
|
DRESSING VASELINE GAUZE 3X9
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS A6223
|
| Hospital Charge Code |
2963775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
DRESSING VASELINE GAUZE 3X9
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS A6223
|
| Hospital Charge Code |
2963775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$14.39
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
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 |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
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 |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$12.65
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
DRESSING XEROFORM 2X2
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS A6222
|
| Hospital Charge Code |
2974367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$12.65
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
DRESSING XEROFORM 2X2
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS A6222
|
| Hospital Charge Code |
2974367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
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 |
$12.23 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.44
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26.21
|
| Rate for Payer: The Alliance Commercial |
$14.39
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
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 |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
DRILL 1.1 MINI QC 310.111
|
Facility
|
OP
|
$1,275.00
|
|
| Hospital Charge Code |
2966169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,219.92 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Aetna Managed Medicare |
$371.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.05
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$994.50
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$795.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$861.90
|
| Rate for Payer: Quartz Medicare Advantage |
$795.60
|
| Rate for Payer: The Alliance Commercial |
$663.00
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.13
|
|
|
DRILL 1.1 MINI QC 310.111
|
Facility
|
IP
|
$1,275.00
|
|
| Hospital Charge Code |
2966169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$1,219.92 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$795.60
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.13
|
|
|
DRILL 1X48 DIAMOND E5210
|
Facility
|
OP
|
$1,464.00
|
|
| Hospital Charge Code |
2964912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
DRILL 1X48 DIAMOND E5210
|
Facility
|
IP
|
$1,464.00
|
|
| Hospital Charge Code |
2964912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
DRILL 2.0/2.4 OSTEOMED 316-0105
|
Facility
|
IP
|
$2,943.00
|
|
| Hospital Charge Code |
2969472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,499.75 |
| Max. Negotiated Rate |
$2,815.86 |
| Rate for Payer: Aetna Commercial |
$2,754.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,632.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,622.18
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna Commercial |
$2,815.86
|
| Rate for Payer: Health EOS Commercial |
$2,724.04
|
| Rate for Payer: HFN Commercial |
$2,815.86
|
| Rate for Payer: Multiplan Commercial |
$2,448.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.75
|
| Rate for Payer: Quartz Commercial |
$1,836.43
|
| Rate for Payer: WEA Trust Commercial |
$1,683.40
|
| Rate for Payer: WPS Commercial |
$2,266.99
|
|
|
DRILL 2.0/2.4 OSTEOMED 316-0105
|
Facility
|
OP
|
$2,943.00
|
|
| Hospital Charge Code |
2969472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.00 |
| Max. Negotiated Rate |
$2,815.86 |
| Rate for Payer: Aetna Commercial |
$2,754.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,632.22
|
| Rate for Payer: Aetna Managed Medicare |
$857.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,469.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,622.18
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna Commercial |
$2,815.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.83
|
| Rate for Payer: Health EOS Commercial |
$2,724.04
|
| Rate for Payer: HFN Commercial |
$2,815.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.54
|
| Rate for Payer: Multiplan Commercial |
$2,448.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.75
|
| Rate for Payer: Quartz Commercial |
$1,989.47
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.43
|
| Rate for Payer: The Alliance Commercial |
$1,530.36
|
| Rate for Payer: WEA Trust Commercial |
$1,683.40
|
| Rate for Payer: WPS Commercial |
$2,266.99
|
|
|
DRILL 2.0 ACUMED
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
2964135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.34 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
DRILL 2.0 ACUMED
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
2964135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.48 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$298.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.55
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$799.50
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$639.60
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
DRILL 2X48 DIAMOND E5220
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964913
|
|
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
|
|
|
DRILL 2X48 DIAMOND E5220
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964913
|
|
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
|
|
|
DRILL 3.2 LONG BIT 71751149
|
Facility
|
IP
|
$2,641.00
|
|
| Hospital Charge Code |
2966009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,345.85 |
| Max. Negotiated Rate |
$2,526.91 |
| Rate for Payer: Aetna Commercial |
$2,471.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.72
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,526.91
|
| Rate for Payer: Health EOS Commercial |
$2,444.51
|
| Rate for Payer: HFN Commercial |
$2,526.91
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,526.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,345.85
|
| Rate for Payer: Quartz Commercial |
$1,647.98
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: WPS Commercial |
$2,034.36
|
|
|
DRILL 3.2 LONG BIT 71751149
|
Facility
|
OP
|
$2,641.00
|
|
| Hospital Charge Code |
2966009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.06 |
| Max. Negotiated Rate |
$2,526.91 |
| Rate for Payer: Aetna Commercial |
$2,471.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.11
|
| Rate for Payer: Aetna Managed Medicare |
$769.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.72
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,526.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.06
|
| Rate for Payer: Health EOS Commercial |
$2,444.51
|
| Rate for Payer: HFN Commercial |
$2,526.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,059.98
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,647.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,526.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,345.85
|
| Rate for Payer: Quartz Commercial |
$1,785.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,647.98
|
| Rate for Payer: The Alliance Commercial |
$1,373.32
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: WPS Commercial |
$2,034.36
|
|
