|
TRACH TUBE FLEX CUFFED SZ 10
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ8 505080
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
2963700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$310.96
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ8 505080
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
2963700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ9 505090
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ9 505090
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE UNCUFF FEN 4.0 4CFN
|
Facility
|
IP
|
$1,516.00
|
|
| Hospital Charge Code |
2963516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.55 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$945.98
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
TRACH TUBE UNCUFF FEN 4.0 4CFN
|
Facility
|
OP
|
$1,516.00
|
|
| Hospital Charge Code |
2963516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.46 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Aetna Managed Medicare |
$441.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,024.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$788.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$882.31
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,182.48
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: NAPHCARE Commercial |
$945.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$1,024.82
|
| Rate for Payer: Quartz Medicare Advantage |
$945.98
|
| Rate for Payer: The Alliance Commercial |
$788.32
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
TRACH TUBE UNCUFF FEN 6.0 6CFN
|
Facility
|
IP
|
$1,516.00
|
|
| Hospital Charge Code |
5385010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.55 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$945.98
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
TRACH TUBE UNCUFF FEN 6.0 6CFN
|
Facility
|
OP
|
$1,516.00
|
|
| Hospital Charge Code |
5385010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.46 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Aetna Managed Medicare |
$441.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,024.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$788.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$882.31
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,182.48
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: NAPHCARE Commercial |
$945.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$1,024.82
|
| Rate for Payer: Quartz Medicare Advantage |
$945.98
|
| Rate for Payer: The Alliance Commercial |
$788.32
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
TRACH TUBE UNCUFF FEN 6.0MM
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2963724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
TRACH TUBE UNCUFF FEN 6.0MM
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2963724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
TRACH TUBE UNCUFF FEN 8.0MM 512080
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2963723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
TRACH TUBE UNCUFF FEN 8.0MM 512080
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2963723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
TRACH TUBE UNCUFF FEN 9.0MM
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2969236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
TRACH TUBE UNCUFF FEN 9.0MM
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2969236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
TRACKER INSTRUMENT EM 9733533
|
Facility
|
OP
|
$2,172.00
|
|
| Hospital Charge Code |
3157476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$632.49 |
| Max. Negotiated Rate |
$2,078.17 |
| Rate for Payer: Aetna Commercial |
$2,032.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,942.64
|
| Rate for Payer: Aetna Managed Medicare |
$632.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,468.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,129.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,084.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,197.21
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$2,078.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,264.10
|
| Rate for Payer: Health EOS Commercial |
$2,010.40
|
| Rate for Payer: HFN Commercial |
$2,078.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,694.16
|
| Rate for Payer: Multiplan Commercial |
$1,807.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,078.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,106.85
|
| Rate for Payer: Quartz Commercial |
$1,468.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,355.33
|
| Rate for Payer: The Alliance Commercial |
$1,129.44
|
| Rate for Payer: WEA Trust Commercial |
$1,242.38
|
| Rate for Payer: WPS Commercial |
$1,673.09
|
|
|
TRACKER INSTRUMENT EM 9733533
|
Facility
|
IP
|
$2,172.00
|
|
| Hospital Charge Code |
3157476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,106.85 |
| Max. Negotiated Rate |
$2,078.17 |
| Rate for Payer: Aetna Commercial |
$2,032.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,942.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,197.21
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$2,078.17
|
| Rate for Payer: Health EOS Commercial |
$2,010.40
|
| Rate for Payer: HFN Commercial |
$2,078.17
|
| Rate for Payer: Multiplan Commercial |
$1,807.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,078.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,106.85
|
| Rate for Payer: Quartz Commercial |
$1,355.33
|
| Rate for Payer: WEA Trust Commercial |
$1,242.38
|
| Rate for Payer: WPS Commercial |
$1,673.09
|
|
|
TRACKER PATIENT EM 9733534/9734887XOM
|
Facility
|
OP
|
$2,775.00
|
|
| Hospital Charge Code |
3157474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$808.08 |
| Max. Negotiated Rate |
$2,655.12 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Aetna Managed Medicare |
$808.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,875.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,385.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,529.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,655.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,615.05
|
| Rate for Payer: Health EOS Commercial |
$2,568.54
|
| Rate for Payer: HFN Commercial |
$2,655.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,164.50
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,731.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.14
|
| Rate for Payer: Quartz Commercial |
$1,875.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,731.60
|
| Rate for Payer: The Alliance Commercial |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
TRACKER PATIENT EM 9733534/9734887XOM
|
Facility
|
IP
|
$2,775.00
|
|
| Hospital Charge Code |
3157474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,414.14 |
| Max. Negotiated Rate |
$2,655.12 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,529.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,655.12
|
| Rate for Payer: Health EOS Commercial |
$2,568.54
|
| Rate for Payer: HFN Commercial |
$2,655.12
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.14
|
| Rate for Payer: Quartz Commercial |
$1,731.60
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
Trac pad
|
Facility
|
IP
|
$346.00
|
|
| Hospital Charge Code |
3006898
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$215.90
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
Trac pad
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
3006898
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$100.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.37
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.88
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$215.90
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$233.90
|
| Rate for Payer: Quartz Medicare Advantage |
$215.90
|
| Rate for Payer: The Alliance Commercial |
$179.92
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
TRACTION AND TRAPEZE
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
3075874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
TRACTION AND TRAPEZE
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
3075874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Traction - Devices and Equipment
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
3002379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Traction - Devices and Equipment
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
3002379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
