|
CABLE 1.6MM X 750MM 6704-8-016
|
Facility
|
IP
|
$2,564.00
|
|
| Hospital Charge Code |
2966072
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| 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 1.6MM X 750MM 6704-8-016
|
Facility
|
OP
|
$2,564.00
|
|
| Hospital Charge Code |
2966072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.92 |
| Max. Negotiated Rate |
$10,256.00 |
| 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: 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 |
$10,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
CABLE 1.8 X 635MM GTR CABLE-READY 2232-05-18
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3687501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,793.40 |
| Max. Negotiated Rate |
$3,367.20 |
| Rate for Payer: Aetna Commercial |
$3,294.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,147.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$3,367.20
|
| Rate for Payer: Health EOS Commercial |
$3,257.40
|
| Rate for Payer: HFN Commercial |
$3,367.20
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,367.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,793.40
|
| Rate for Payer: Quartz Commercial |
$2,196.00
|
| Rate for Payer: WEA Trust Commercial |
$2,013.00
|
| Rate for Payer: WPS Commercial |
$2,710.96
|
|
|
CABLE 1.8 X 635MM GTR CABLE-READY 2232-05-18
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3687501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.80 |
| Max. Negotiated Rate |
$14,640.00 |
| Rate for Payer: Aetna Commercial |
$3,294.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,147.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,024.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,379.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,830.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,756.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$3,367.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,048.14
|
| Rate for Payer: Health EOS Commercial |
$3,257.40
|
| Rate for Payer: HFN Commercial |
$3,367.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,745.00
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,367.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,793.40
|
| Rate for Payer: Quartz Commercial |
$2,379.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,196.00
|
| Rate for Payer: The Alliance Commercial |
$14,640.00
|
| Rate for Payer: WEA Trust Commercial |
$2,013.00
|
| Rate for Payer: WPS Commercial |
$2,710.96
|
|
|
CABLE 2.0MM BEADED & SLEEVE VITALLIUM 6704-0-520
|
Facility
|
OP
|
$4,180.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.40 |
| Max. Negotiated Rate |
$16,720.00 |
| Rate for Payer: Aetna Commercial |
$3,762.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,594.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,170.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,717.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,090.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,006.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.40
|
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Cigna Commercial |
$3,845.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,339.13
|
| Rate for Payer: Health EOS Commercial |
$3,720.20
|
| Rate for Payer: HFN Commercial |
$3,845.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,135.00
|
| Rate for Payer: Multiplan Commercial |
$3,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,508.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,845.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.20
|
| Rate for Payer: Quartz Commercial |
$2,717.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,508.00
|
| Rate for Payer: The Alliance Commercial |
$16,720.00
|
| Rate for Payer: WEA Trust Commercial |
$2,299.00
|
| Rate for Payer: WPS Commercial |
$3,096.13
|
|
|
CABLE 2.0MM BEADED & SLEEVE VITALLIUM 6704-0-520
|
Facility
|
IP
|
$4,180.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,048.20 |
| Max. Negotiated Rate |
$3,845.60 |
| Rate for Payer: Aetna Commercial |
$3,762.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,594.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.40
|
| Rate for Payer: Cash Price |
$1,254.00
|
| Rate for Payer: Cigna Commercial |
$3,845.60
|
| Rate for Payer: Health EOS Commercial |
$3,720.20
|
| Rate for Payer: HFN Commercial |
$3,845.60
|
| Rate for Payer: Multiplan Commercial |
$3,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,508.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,845.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.20
|
| Rate for Payer: Quartz Commercial |
$2,508.00
|
| Rate for Payer: WEA Trust Commercial |
$2,299.00
|
| Rate for Payer: WPS Commercial |
$3,096.13
|
|
|
CABLE 2.0MM X 750MM 6704-8-240
|
Facility
|
IP
|
$2,564.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966073
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| 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 2.0MM X 750MM 6704-8-240
|
Facility
|
OP
|
$2,564.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.92 |
| Max. Negotiated Rate |
$10,256.00 |
| 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: 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 |
$10,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
CABLE/CRIMP 1.7MM SYNTHES 298.801.01S
|
Facility
|
IP
|
$4,957.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,428.93 |
| Max. Negotiated Rate |
$4,560.44 |
| Rate for Payer: Aetna Commercial |
$4,461.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,263.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,627.21
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,560.44
|
| Rate for Payer: Health EOS Commercial |
$4,411.73
|
| Rate for Payer: HFN Commercial |
$4,560.44
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,974.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,560.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.93
|
| Rate for Payer: Quartz Commercial |
$2,974.20
|
| Rate for Payer: WEA Trust Commercial |
$2,726.35
|
| Rate for Payer: WPS Commercial |
$3,671.65
|
|
|
CABLE/CRIMP 1.7MM SYNTHES 298.801.01S
|
Facility
|
OP
|
$4,957.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.96 |
| Max. Negotiated Rate |
$19,828.00 |
| Rate for Payer: Aetna Commercial |
$4,461.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,263.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,222.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,478.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,379.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,627.21
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,560.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,773.94
|
| Rate for Payer: Health EOS Commercial |
$4,411.73
|
| Rate for Payer: HFN Commercial |
$4,560.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,717.75
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,974.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,560.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.93
|
| Rate for Payer: Quartz Commercial |
$3,222.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,974.20
|
| Rate for Payer: The Alliance Commercial |
$19,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,726.35
|
| Rate for Payer: WPS Commercial |
$3,671.65
|
|
|
CABLE INTEGRAL LONG GTR W/4 23 X 121MM 2232-02-05
|
Facility
|
IP
|
$13,052.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4147200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,395.48 |
| Max. Negotiated Rate |
$12,007.84 |
| Rate for Payer: Aetna Commercial |
$11,746.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,224.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,917.56
|
| Rate for Payer: Cash Price |
$3,915.60
|
| Rate for Payer: Cigna Commercial |
$12,007.84
|
| Rate for Payer: Health EOS Commercial |
$11,616.28
|
| Rate for Payer: HFN Commercial |
$12,007.84
|
| Rate for Payer: Multiplan Commercial |
$10,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,831.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,007.84
|
| Rate for Payer: Quartz Beloit One Network |
$6,395.48
|
| Rate for Payer: Quartz Commercial |
$7,831.20
|
| Rate for Payer: WEA Trust Commercial |
$7,178.60
|
| Rate for Payer: WPS Commercial |
$9,667.62
|
|
|
CABLE INTEGRAL LONG GTR W/4 23 X 121MM 2232-02-05
|
Facility
|
OP
|
$13,052.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4147200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,654.56 |
| Max. Negotiated Rate |
$52,208.00 |
| Rate for Payer: Aetna Commercial |
$11,746.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,224.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,654.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,483.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,526.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,264.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,917.56
|
| Rate for Payer: Cash Price |
$3,915.60
|
| Rate for Payer: Cigna Commercial |
$12,007.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,303.90
|
| Rate for Payer: Health EOS Commercial |
$11,616.28
|
| Rate for Payer: HFN Commercial |
$12,007.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,789.00
|
| Rate for Payer: Multiplan Commercial |
$10,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,831.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,007.84
|
| Rate for Payer: Quartz Beloit One Network |
$6,395.48
|
| Rate for Payer: Quartz Commercial |
$8,483.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,831.20
|
| Rate for Payer: The Alliance Commercial |
$52,208.00
|
| Rate for Payer: WEA Trust Commercial |
$7,178.60
|
| Rate for Payer: WPS Commercial |
$9,667.62
|
|
|
CABLE INTEGRAL LONG GTR W/4 23 X 232MM 2232-02-06
|
Facility
|
IP
|
$20,359.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3697509
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$17,508.74
|
| 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 232MM 2232-02-06
|
Facility
|
OP
|
$20,359.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3697509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,700.52 |
| Max. Negotiated Rate |
$81,436.00 |
| 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: 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 |
$81,436.00
|
| 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 |
$5,700.52 |
| Max. Negotiated Rate |
$81,436.00 |
| 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: 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 |
$81,436.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$17,508.74
|
| 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 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 |
$2,291.80 |
| Max. Negotiated Rate |
$32,740.00 |
| 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: 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 |
$32,740.00
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$7,039.10
|
| 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 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 |
$1,296.00 |
| 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: The Alliance Commercial |
$1,296.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| 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 |
$10,256.00 |
| 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: 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 |
$10,256.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| 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 |
$10,644.00 |
| 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: 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 |
$10,644.00
|
| 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 |
$10,256.00 |
| 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: 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 |
$10,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
