|
CABLE INTEGRAL LONG GTR W/4 23 X 232MM 2232-02-06
|
Facility
OP
|
$20,359.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3697509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.24 |
| Max. Negotiated Rate |
$18,730.28 |
| Rate for Payer: Aetna Commercial |
$18,323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,508.74
|
| Rate for Payer: Aetna Managed Medicare |
$5,700.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,233.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,772.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,790.27
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$18,730.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,392.90
|
| Rate for Payer: Health EOS Commercial |
$18,119.51
|
| Rate for Payer: HFN Commercial |
$18,730.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,269.25
|
| Rate for Payer: Multiplan Commercial |
$16,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,730.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,975.91
|
| Rate for Payer: Quartz Commercial |
$13,233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,215.40
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$11,197.45
|
| Rate for Payer: WPS Commercial |
$15,079.91
|
|
|
CABLE INTEGRAL LONG GTR W/4 23 X 261MM 2232-02-07
|
Facility
IP
|
$20,359.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5563434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,975.91 |
| Max. Negotiated Rate |
$18,730.28 |
| Rate for Payer: Aetna Commercial |
$18,323.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,790.27
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$18,730.28
|
| Rate for Payer: Health EOS Commercial |
$18,119.51
|
| Rate for Payer: HFN Commercial |
$18,730.28
|
| Rate for Payer: Multiplan Commercial |
$16,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,730.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,975.91
|
| Rate for Payer: Quartz Commercial |
$12,215.40
|
| Rate for Payer: WEA Trust Commercial |
$11,197.45
|
| Rate for Payer: WPS Commercial |
$15,079.91
|
|
|
CABLE INTEGRAL LONG GTR W/4 23 X 261MM 2232-02-07
|
Facility
OP
|
$20,359.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5563434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.24 |
| Max. Negotiated Rate |
$18,730.28 |
| Rate for Payer: Aetna Commercial |
$18,323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,508.74
|
| Rate for Payer: Aetna Managed Medicare |
$5,700.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,233.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,772.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,790.27
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$18,730.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,392.90
|
| Rate for Payer: Health EOS Commercial |
$18,119.51
|
| Rate for Payer: HFN Commercial |
$18,730.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,269.25
|
| Rate for Payer: Multiplan Commercial |
$16,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,730.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,975.91
|
| Rate for Payer: Quartz Commercial |
$13,233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,215.40
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$11,197.45
|
| Rate for Payer: WPS Commercial |
$15,079.91
|
|
|
CABLE INTEGRAL SHORT GTR W/2 23 X 53MM 2232-02-04
|
Facility
IP
|
$8,185.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5521104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,010.65 |
| Max. Negotiated Rate |
$7,530.20 |
| Rate for Payer: Aetna Commercial |
$7,366.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,338.05
|
| Rate for Payer: Cash Price |
$2,455.50
|
| Rate for Payer: Cigna Commercial |
$7,530.20
|
| Rate for Payer: Health EOS Commercial |
$7,284.65
|
| Rate for Payer: HFN Commercial |
$7,530.20
|
| Rate for Payer: Multiplan Commercial |
$6,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,911.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,530.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,010.65
|
| Rate for Payer: Quartz Commercial |
$4,911.00
|
| Rate for Payer: WEA Trust Commercial |
$4,501.75
|
| Rate for Payer: WPS Commercial |
$6,062.63
|
|
|
CABLE INTEGRAL SHORT GTR W/2 23 X 53MM 2232-02-04
|
Facility
OP
|
$8,185.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5521104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.24 |
| Max. Negotiated Rate |
$7,530.20 |
| Rate for Payer: Aetna Commercial |
$7,366.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,039.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,320.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,092.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,928.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,338.05
|
| Rate for Payer: Cash Price |
$2,455.50
|
| Rate for Payer: Cash Price |
$2,455.50
|
| Rate for Payer: Cigna Commercial |
$7,530.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,580.33
|
| Rate for Payer: Health EOS Commercial |
$7,284.65
|
| Rate for Payer: HFN Commercial |
$7,530.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,138.75
|
| Rate for Payer: Multiplan Commercial |
$6,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,911.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,530.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,010.65
|
| Rate for Payer: Quartz Commercial |
$5,320.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,911.00
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$4,501.75
|
| Rate for Payer: WPS Commercial |
$6,062.63
|
|
|
CABLE PACING 8 FT DISP EXT W SAFETY CONNECT/ALLIGATOR CLIP S-201-97
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.72 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Aetna Managed Medicare |
$90.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$210.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$155.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.31
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.00
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$210.60
|
| Rate for Payer: Quartz Medicare Advantage |
$194.40
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
CABLE PACING 8 FT DISP EXT W SAFETY CONNECT/ALLIGATOR CLIP S-201-97
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$194.40
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
CABLE/SLEEVE 1.6 6704-0-410
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.92 |
| Max. Negotiated Rate |
$2,358.88 |
| Rate for Payer: Aetna Commercial |
$2,307.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| Rate for Payer: Aetna Managed Medicare |
$717.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,666.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,282.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.92
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,358.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.81
|
| Rate for Payer: Health EOS Commercial |
$2,281.96
|
| Rate for Payer: HFN Commercial |
$2,358.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,923.00
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.36
|
| Rate for Payer: Quartz Commercial |
$1,666.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,538.40
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
CABLE/SLEEVE 1.6 6704-0-410
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.36 |
| Max. Negotiated Rate |
$2,358.88 |
| Rate for Payer: Aetna Commercial |
$2,307.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.92
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,358.88
|
| Rate for Payer: Health EOS Commercial |
$2,281.96
|
| Rate for Payer: HFN Commercial |
$2,358.88
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.36
|
| Rate for Payer: Quartz Commercial |
$1,538.40
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
CABLE/SLEEVE 1.6 BEADED 3704-0-040
|
Facility
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.89 |
| Max. Negotiated Rate |
$2,448.12 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,596.60
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
CABLE/SLEEVE 1.6 BEADED 3704-0-040
|
Facility
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.08 |
| Max. Negotiated Rate |
$2,448.12 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| Rate for Payer: Aetna Managed Medicare |
$745.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,277.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,489.10
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.75
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,729.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.60
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
CABLE/SLEEVE 2.0 6704-0-510
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.92 |
| Max. Negotiated Rate |
$2,358.88 |
| Rate for Payer: Aetna Commercial |
$2,307.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| Rate for Payer: Aetna Managed Medicare |
$717.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,666.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,282.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.92
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,358.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.81
|
| Rate for Payer: Health EOS Commercial |
$2,281.96
|
| Rate for Payer: HFN Commercial |
$2,358.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,923.00
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.36
|
| Rate for Payer: Quartz Commercial |
$1,666.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,538.40
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
CABLE/SLEEVE 2.0 6704-0-510
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.36 |
| Max. Negotiated Rate |
$2,358.88 |
| Rate for Payer: Aetna Commercial |
$2,307.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.92
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,358.88
|
| Rate for Payer: Health EOS Commercial |
$2,281.96
|
| Rate for Payer: HFN Commercial |
$2,358.88
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.36
|
| Rate for Payer: Quartz Commercial |
$1,538.40
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
CABLE/SLEEVE 2.0 BEADED 3704-0-050
|
Facility
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.89 |
| Max. Negotiated Rate |
$2,448.12 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,596.60
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
CABLE/SLEEVE 2.0 BEADED 3704-0-050
|
Facility
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.08 |
| Max. Negotiated Rate |
$2,448.12 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| Rate for Payer: Aetna Managed Medicare |
$745.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,277.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,489.10
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.75
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,729.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.60
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
CABLE SLEEVE 2.0MM MEDIUM 6704-4-020
|
Facility
OP
|
$1,664.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$465.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.17
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$998.40
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
CABLE SLEEVE 2.0MM MEDIUM 6704-4-020
|
Facility
IP
|
$1,664.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
Ca Channel Bind Antibody SN Type
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$17.72
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
Ca Channel Bind Antibody SN Type
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.05
|
| Rate for Payer: Dean Health Medicaid |
$12.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.05
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.05
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Ca Channel Bind Antibody SN Type
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
CA Channel Bind Antibody SP/Q Type
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
CA Channel Bind Antibody SP/Q Type
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$17.72
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
CA Channel Bind Antibody SP/Q Type
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.05
|
| Rate for Payer: Dean Health Medicaid |
$12.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.05
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.05
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
CAD for Screening Mammography
|
Facility
OP
|
$82.00
|
|
| Hospital Charge Code |
1158804
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
CAD for Screening Mammography
|
Facility
IP
|
$82.00
|
|
| Hospital Charge Code |
1158804
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
