|
TRACKER PATIENT EM 9733534/9734887XOM
|
Facility
IP
|
$2,775.00
|
|
| Hospital Charge Code |
3157474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,359.75 |
| Max. Negotiated Rate |
$2,553.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,665.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
TRACKER PATIENT EM 9733534/9734887XOM
|
Facility
OP
|
$2,775.00
|
|
| Hospital Charge Code |
3157474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$11,100.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Aetna Managed Medicare |
$777.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,552.89
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,081.25
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,803.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,665.00
|
| Rate for Payer: The Alliance Commercial |
$11,100.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
Trac pad
|
Facility
OP
|
$346.00
|
|
| Hospital Charge Code |
3006898
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$96.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.62
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$207.60
|
| Rate for Payer: The Alliance Commercial |
$1,384.00
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Trac pad
|
Facility
IP
|
$346.00
|
|
| Hospital Charge Code |
3006898
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
TRACTION AND TRAPEZE
|
Facility
IP
|
$72.00
|
|
| Hospital Charge Code |
3075874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
TRACTION AND TRAPEZE
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
3075874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Traction - Devices and Equipment
|
Facility
IP
|
$75.00
|
|
| Hospital Charge Code |
3002379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Traction - Devices and Equipment
|
Facility
OP
|
$75.00
|
|
| Hospital Charge Code |
3002379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Trail Blazer
|
Facility
IP
|
$6,174.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139306
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,025.26 |
| Max. Negotiated Rate |
$5,680.08 |
| Rate for Payer: Aetna Commercial |
$5,556.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,272.22
|
| Rate for Payer: Cash Price |
$1,852.20
|
| Rate for Payer: Cigna Commercial |
$5,680.08
|
| Rate for Payer: Health EOS Commercial |
$5,494.86
|
| Rate for Payer: HFN Commercial |
$5,680.08
|
| Rate for Payer: Multiplan Commercial |
$4,939.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,704.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,680.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,025.26
|
| Rate for Payer: Quartz Commercial |
$3,704.40
|
| Rate for Payer: WEA Trust Commercial |
$3,395.70
|
| Rate for Payer: WPS Commercial |
$4,573.08
|
|
|
Trail Blazer
|
Facility
OP
|
$6,174.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139306
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,728.72 |
| Max. Negotiated Rate |
$5,680.08 |
| Rate for Payer: Aetna Commercial |
$5,556.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,309.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,728.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,013.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,963.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,272.22
|
| Rate for Payer: Cash Price |
$1,852.20
|
| Rate for Payer: Cigna Commercial |
$5,680.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,454.97
|
| Rate for Payer: Health EOS Commercial |
$5,494.86
|
| Rate for Payer: HFN Commercial |
$5,680.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,630.50
|
| Rate for Payer: Multiplan Commercial |
$4,939.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,704.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,680.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,025.26
|
| Rate for Payer: Quartz Commercial |
$4,013.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,704.40
|
| Rate for Payer: WEA Trust Commercial |
$3,395.70
|
| Rate for Payer: WPS Commercial |
$4,573.08
|
|
|
Trailblazer .014 135cm
|
Facility
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .014 135cm
|
Professional
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .014 135cm
|
Facility
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
TRAILBLAZER .014 135CM #SC-014-135
|
Facility
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
TRAILBLAZER .014 135CM #SC-014-135
|
Facility
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
Trailblazer .035 135cm
|
Facility
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .035 135cm
|
Professional
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .035 135cm
|
Facility
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .035 65cm
|
Professional
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .035 65cm
|
Facility
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Trailblazer .035 65cm
|
Facility
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
TRAILBLAZER .035 X 65CM
|
Facility
IP
|
$2,139.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
TRAILBLAZER .035 X 65CM
|
Facility
OP
|
$2,139.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.92 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
Tramadol Level
|
Professional
|
$240.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
4682606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Tramadol Level
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
4682606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
