|
LINER CONTINUUM VE ELEVATED HH 32MM 00-8852-009-32
|
Facility
|
OP
|
$10,185.00
|
|
| Hospital Charge Code |
4520252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.87 |
| Max. Negotiated Rate |
$9,745.01 |
| Rate for Payer: Aetna Commercial |
$9,533.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,109.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,965.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,885.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,296.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,084.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,613.97
|
| Rate for Payer: Cash Price |
$3,055.50
|
| Rate for Payer: Cigna Commercial |
$9,745.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,927.67
|
| Rate for Payer: Health EOS Commercial |
$9,427.24
|
| Rate for Payer: HFN Commercial |
$9,745.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,944.30
|
| Rate for Payer: Multiplan Commercial |
$8,473.92
|
| Rate for Payer: NAPHCARE Commercial |
$6,355.44
|
| Rate for Payer: Preferred Network Access Commercial |
$9,745.01
|
| Rate for Payer: Quartz Beloit One Network |
$5,190.28
|
| Rate for Payer: Quartz Commercial |
$6,885.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6,355.44
|
| Rate for Payer: The Alliance Commercial |
$5,296.20
|
| Rate for Payer: WEA Trust Commercial |
$5,825.82
|
| Rate for Payer: WPS Commercial |
$7,845.51
|
|
|
LINER CONTINUUM VE ELEVATED II 36MM 00-8852-010-36
|
Facility
|
IP
|
$10,576.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3279474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,389.53 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$6,599.42
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED II 36MM 00-8852-010-36
|
Facility
|
OP
|
$10,576.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3279474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.73 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,079.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,149.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,499.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,279.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,155.23
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,249.28
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,599.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$7,149.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,599.42
|
| Rate for Payer: The Alliance Commercial |
$5,499.52
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED JJ 36MM X 54 00-8852-011-36
|
Facility
|
IP
|
$10,576.00
|
|
| Hospital Charge Code |
3529521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,389.53 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$6,599.42
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED JJ 36MM X 54 00-8852-011-36
|
Facility
|
OP
|
$10,576.00
|
|
| Hospital Charge Code |
3529521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.73 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,079.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,149.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,499.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,279.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,155.23
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,249.28
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,599.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$7,149.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,599.42
|
| Rate for Payer: The Alliance Commercial |
$5,499.52
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED KK 36MM X 56 00-8852-012-36
|
Facility
|
OP
|
$10,576.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3583491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.73 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,079.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,149.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,499.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,279.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,155.23
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,249.28
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,599.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$7,149.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,599.42
|
| Rate for Payer: The Alliance Commercial |
$5,499.52
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED KK 36MM X 56 00-8852-012-36
|
Facility
|
IP
|
$10,576.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3583491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,389.53 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$6,599.42
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED LL 36MM X 58 00-8852-013-36
|
Facility
|
IP
|
$10,576.00
|
|
| Hospital Charge Code |
3365526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,389.53 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$6,599.42
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED LL 36MM X 58 00-8852-013-36
|
Facility
|
OP
|
$10,576.00
|
|
| Hospital Charge Code |
3365526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.73 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,079.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,149.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,499.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,279.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,155.23
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,249.28
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,599.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$7,149.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,599.42
|
| Rate for Payer: The Alliance Commercial |
$5,499.52
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED MM 36MM X 60 00-8852-014-36
|
Facility
|
OP
|
$10,576.00
|
|
| Hospital Charge Code |
3763526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.73 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,079.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,149.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,499.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,279.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,155.23
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,249.28
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,599.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$7,149.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,599.42
|
| Rate for Payer: The Alliance Commercial |
$5,499.52
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED MM 36MM X 60 00-8852-014-36
|
Facility
|
IP
|
$10,576.00
|
|
| Hospital Charge Code |
3763526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,389.53 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$6,599.42
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED NN 36MM 00-8852-015-36
|
Facility
|
IP
|
$10,576.00
|
|
| Hospital Charge Code |
3279475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,389.53 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$6,599.42
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER CONTINUUM VE ELEVATED NN 36MM 00-8852-015-36
|
Facility
|
OP
|
$10,576.00
|
|
| Hospital Charge Code |
3279475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.73 |
| Max. Negotiated Rate |
$10,119.12 |
| Rate for Payer: Aetna Commercial |
$9,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,459.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,079.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,149.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,499.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,279.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,829.49
|
| Rate for Payer: Cash Price |
$3,172.80
|
| Rate for Payer: Cigna Commercial |
$10,119.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,155.23
|
| Rate for Payer: Health EOS Commercial |
$9,789.15
|
| Rate for Payer: HFN Commercial |
$10,119.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,249.28
|
| Rate for Payer: Multiplan Commercial |
$8,799.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,599.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,119.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,389.53
|
| Rate for Payer: Quartz Commercial |
$7,149.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,599.42
|
| Rate for Payer: The Alliance Commercial |
$5,499.52
|
| Rate for Payer: WEA Trust Commercial |
$6,049.47
|
| Rate for Payer: WPS Commercial |
$8,146.69
|
|
|
LINER LONG. 32x48 20 DEG ELEV
|
Facility
|
OP
|
$7,272.00
|
|
| Hospital Charge Code |
2967496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,117.61 |
| Max. Negotiated Rate |
$6,957.85 |
| Rate for Payer: Aetna Commercial |
$6,806.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,504.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,117.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,915.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,781.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,630.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,008.33
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cigna Commercial |
$6,957.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,232.30
|
| Rate for Payer: Health EOS Commercial |
$6,730.96
|
| Rate for Payer: HFN Commercial |
$6,957.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,672.16
|
| Rate for Payer: Multiplan Commercial |
$6,050.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,537.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,957.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,705.81
|
| Rate for Payer: Quartz Commercial |
$4,915.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,537.73
|
| Rate for Payer: The Alliance Commercial |
$3,781.44
|
| Rate for Payer: WEA Trust Commercial |
$4,159.58
|
| Rate for Payer: WPS Commercial |
$5,601.62
|
|
|
LINER LONG. 32x48 20 DEG ELEV
|
Facility
|
IP
|
$7,272.00
|
|
| Hospital Charge Code |
2967496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,705.81 |
| Max. Negotiated Rate |
$6,957.85 |
| Rate for Payer: Aetna Commercial |
$6,806.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,504.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,008.33
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cigna Commercial |
$6,957.85
|
| Rate for Payer: Health EOS Commercial |
$6,730.96
|
| Rate for Payer: HFN Commercial |
$6,957.85
|
| Rate for Payer: Multiplan Commercial |
$6,050.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,957.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,705.81
|
| Rate for Payer: Quartz Commercial |
$4,537.73
|
| Rate for Payer: WEA Trust Commercial |
$4,159.58
|
| Rate for Payer: WPS Commercial |
$5,601.62
|
|
|
LINER LONGEVITY 40x58
|
Facility
|
IP
|
$10,183.00
|
|
| Hospital Charge Code |
2967497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.26 |
| Max. Negotiated Rate |
$9,743.09 |
| Rate for Payer: Aetna Commercial |
$9,531.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,107.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,612.87
|
| Rate for Payer: Cash Price |
$3,054.90
|
| Rate for Payer: Cigna Commercial |
$9,743.09
|
| Rate for Payer: Health EOS Commercial |
$9,425.38
|
| Rate for Payer: HFN Commercial |
$9,743.09
|
| Rate for Payer: Multiplan Commercial |
$8,472.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,743.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,189.26
|
| Rate for Payer: Quartz Commercial |
$6,354.19
|
| Rate for Payer: WEA Trust Commercial |
$5,824.68
|
| Rate for Payer: WPS Commercial |
$7,843.96
|
|
|
LINER LONGEVITY 40x58
|
Facility
|
OP
|
$10,183.00
|
|
| Hospital Charge Code |
2967497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.29 |
| Max. Negotiated Rate |
$9,743.09 |
| Rate for Payer: Aetna Commercial |
$9,531.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,107.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,965.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,883.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,295.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,083.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,612.87
|
| Rate for Payer: Cash Price |
$3,054.90
|
| Rate for Payer: Cigna Commercial |
$9,743.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,926.51
|
| Rate for Payer: Health EOS Commercial |
$9,425.38
|
| Rate for Payer: HFN Commercial |
$9,743.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,942.74
|
| Rate for Payer: Multiplan Commercial |
$8,472.26
|
| Rate for Payer: NAPHCARE Commercial |
$6,354.19
|
| Rate for Payer: Preferred Network Access Commercial |
$9,743.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,189.26
|
| Rate for Payer: Quartz Commercial |
$6,883.71
|
| Rate for Payer: Quartz Medicare Advantage |
$6,354.19
|
| Rate for Payer: The Alliance Commercial |
$5,295.16
|
| Rate for Payer: WEA Trust Commercial |
$5,824.68
|
| Rate for Payer: WPS Commercial |
$7,843.96
|
|
|
LINER LONGEVITY 44X28 10 DEG 6310-44-28
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER LONGEVITY 44X28 10 DEG 6310-44-28
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER LONGEVITY 46X28 10 DEG 6310-46-28
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER LONGEVITY 46X28 10 DEG 6310-46-28
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER MULTIPOLAR BIPOLAR CUP 44/45/46 5001-44-28
|
Facility
|
OP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3138909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.88 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Aetna Managed Medicare |
$903.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,098.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,614.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,549.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.53
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,421.12
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$2,098.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,936.90
|
| Rate for Payer: The Alliance Commercial |
$1,614.08
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
LINER MULTIPOLAR BIPOLAR CUP 44/45/46 5001-44-28
|
Facility
|
IP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3138909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.80 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$1,936.90
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
Lipase Level
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.17 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.57
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$141.02
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
|
Lipase Level
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$152.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: United Healthcare PPO |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: Wellcare Medicare |
$7.17
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
