|
TRACH TUBE FLEX CUFFED SZ 10
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ8 505080
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
2963700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ8 505080
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
2963700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.64
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$2,392.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ9 505090
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ9 505090
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE UNCUFF FEN 4.0 4CFN
|
Facility
|
IP
|
$1,516.00
|
|
| Hospital Charge Code |
2963516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.84 |
| Max. Negotiated Rate |
$1,394.72 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$909.60
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
TRACH TUBE UNCUFF FEN 4.0 4CFN
|
Facility
|
OP
|
$1,516.00
|
|
| Hospital Charge Code |
2963516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.48 |
| Max. Negotiated Rate |
$6,064.00 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Aetna Managed Medicare |
$424.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$985.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.35
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$985.40
|
| Rate for Payer: Quartz Medicare Advantage |
$909.60
|
| Rate for Payer: The Alliance Commercial |
$6,064.00
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
TRACH TUBE UNCUFF FEN 6.0 6CFN
|
Facility
|
OP
|
$1,516.00
|
|
| Hospital Charge Code |
5385010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.48 |
| Max. Negotiated Rate |
$6,064.00 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Aetna Managed Medicare |
$424.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$985.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.35
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$985.40
|
| Rate for Payer: Quartz Medicare Advantage |
$909.60
|
| Rate for Payer: The Alliance Commercial |
$6,064.00
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
TRACH TUBE UNCUFF FEN 6.0 6CFN
|
Facility
|
IP
|
$1,516.00
|
|
| Hospital Charge Code |
5385010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.84 |
| Max. Negotiated Rate |
$1,394.72 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$909.60
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
TRACH TUBE UNCUFF FEN 6.0MM
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2963724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
TRACH TUBE UNCUFF FEN 6.0MM
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2963724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
TRACH TUBE UNCUFF FEN 8.0MM 512080
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2963723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
TRACH TUBE UNCUFF FEN 8.0MM 512080
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2963723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
TRACH TUBE UNCUFF FEN 9.0MM
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2969236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
TRACH TUBE UNCUFF FEN 9.0MM
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2969236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
TRACKER INSTRUMENT EM 9733533
|
Facility
|
OP
|
$2,172.00
|
|
| Hospital Charge Code |
3157476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$608.16 |
| Max. Negotiated Rate |
$8,688.00 |
| Rate for Payer: Aetna Commercial |
$1,954.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,867.92
|
| Rate for Payer: Aetna Managed Medicare |
$608.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,411.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,086.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,042.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,151.16
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$1,998.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,215.45
|
| Rate for Payer: Health EOS Commercial |
$1,933.08
|
| Rate for Payer: HFN Commercial |
$1,998.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,629.00
|
| Rate for Payer: Multiplan Commercial |
$1,737.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,303.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,998.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,064.28
|
| Rate for Payer: Quartz Commercial |
$1,411.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,303.20
|
| Rate for Payer: The Alliance Commercial |
$8,688.00
|
| Rate for Payer: WEA Trust Commercial |
$1,194.60
|
| Rate for Payer: WPS Commercial |
$1,608.80
|
|
|
TRACKER INSTRUMENT EM 9733533
|
Facility
|
IP
|
$2,172.00
|
|
| Hospital Charge Code |
3157476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,064.28 |
| Max. Negotiated Rate |
$1,998.24 |
| Rate for Payer: Aetna Commercial |
$1,954.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,867.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,151.16
|
| Rate for Payer: Cash Price |
$651.60
|
| Rate for Payer: Cigna Commercial |
$1,998.24
|
| Rate for Payer: Health EOS Commercial |
$1,933.08
|
| Rate for Payer: HFN Commercial |
$1,998.24
|
| Rate for Payer: Multiplan Commercial |
$1,737.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,303.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,998.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,064.28
|
| Rate for Payer: Quartz Commercial |
$1,303.20
|
| Rate for Payer: WEA Trust Commercial |
$1,194.60
|
| Rate for Payer: WPS Commercial |
$1,608.80
|
|
|
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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| 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
|
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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| 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
|
|
