|
Trail Blazer
|
Facility
|
OP
|
$6,174.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139306
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,797.87 |
| Max. Negotiated Rate |
$5,907.28 |
| Rate for Payer: Aetna Commercial |
$5,778.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,797.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,173.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,210.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,082.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,403.11
|
| Rate for Payer: Cash Price |
$1,852.20
|
| Rate for Payer: Cigna Commercial |
$5,907.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,593.27
|
| Rate for Payer: Health EOS Commercial |
$5,714.65
|
| Rate for Payer: HFN Commercial |
$5,907.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,815.72
|
| Rate for Payer: Multiplan Commercial |
$5,136.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,852.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.27
|
| Rate for Payer: Quartz Commercial |
$4,173.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,852.58
|
| Rate for Payer: The Alliance Commercial |
$3,210.48
|
| Rate for Payer: WEA Trust Commercial |
$3,531.53
|
| Rate for Payer: WPS Commercial |
$4,755.83
|
|
|
Trail Blazer
|
Facility
|
IP
|
$6,174.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139306
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,146.27 |
| Max. Negotiated Rate |
$5,907.28 |
| Rate for Payer: Aetna Commercial |
$5,778.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,403.11
|
| Rate for Payer: Cash Price |
$1,852.20
|
| Rate for Payer: Cigna Commercial |
$5,907.28
|
| Rate for Payer: Health EOS Commercial |
$5,714.65
|
| Rate for Payer: HFN Commercial |
$5,907.28
|
| Rate for Payer: Multiplan Commercial |
$5,136.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.27
|
| Rate for Payer: Quartz Commercial |
$3,852.58
|
| Rate for Payer: WEA Trust Commercial |
$3,531.53
|
| Rate for Payer: WPS Commercial |
$4,755.83
|
|
|
Trailblazer .014 135cm
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .014 135cm
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .014 135cm
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
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 |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
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 |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
Trailblazer .035 135cm
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .035 135cm
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .035 135cm
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .035 65cm
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .035 65cm
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Trailblazer .035 65cm
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
TRAILBLAZER .035 X 65CM
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
TRAILBLAZER .035 X 65CM
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
Tramadol Level
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
4682606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$69.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$149.76
|
| Rate for Payer: The Alliance Commercial |
$124.80
|
| Rate for Payer: United Healthcare PPO |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Tramadol Level
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
4682606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.76
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: The Alliance Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Tramadol Level
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
4682606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Tramadol , Quantitative Urine
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5084606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$34.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$74.88
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: United Healthcare PPO |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Tramadol , Quantitative Urine
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5084606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.91 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.88
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Tramadol , Quantitative Urine
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5084606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
.Tramadol Quant Urine
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5088606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$293.44 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$293.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.33
|
| Rate for Payer: Health EOS Commercial |
$281.08
|
| Rate for Payer: HFN Commercial |
$293.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$293.44
|
| Rate for Payer: Quartz Beloit One Network |
$135.91
|
| Rate for Payer: Quartz Commercial |
$176.06
|
| Rate for Payer: The Alliance Commercial |
$154.44
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
.Tramadol Quant Urine
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5088606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
.Tramadol Quant Urine
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5088606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.49 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$86.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.85
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.66
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$185.33
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$185.33
|
| Rate for Payer: The Alliance Commercial |
$154.44
|
| Rate for Payer: United Healthcare PPO |
$231.66
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
TRANFIXING PIN 5MM X 300MM 5050-5-300
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.96 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
