|
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 |
$10,374.95 |
| Max. Negotiated Rate |
$19,479.49 |
| Rate for Payer: Aetna Commercial |
$19,056.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,209.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,221.88
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$19,479.49
|
| Rate for Payer: Health EOS Commercial |
$18,844.29
|
| Rate for Payer: HFN Commercial |
$19,479.49
|
| Rate for Payer: Multiplan Commercial |
$16,938.69
|
| Rate for Payer: Preferred Network Access Commercial |
$19,479.49
|
| Rate for Payer: Quartz Beloit One Network |
$10,374.95
|
| Rate for Payer: Quartz Commercial |
$12,704.02
|
| Rate for Payer: WEA Trust Commercial |
$11,645.35
|
| Rate for Payer: WPS Commercial |
$15,682.54
|
|
|
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 |
$5,928.54 |
| Max. Negotiated Rate |
$19,479.49 |
| Rate for Payer: Aetna Commercial |
$19,056.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,209.09
|
| Rate for Payer: Aetna Managed Medicare |
$5,928.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,762.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,586.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,163.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,221.88
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$19,479.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,848.94
|
| Rate for Payer: Health EOS Commercial |
$18,844.29
|
| Rate for Payer: HFN Commercial |
$19,479.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,880.02
|
| Rate for Payer: Multiplan Commercial |
$16,938.69
|
| Rate for Payer: NAPHCARE Commercial |
$12,704.02
|
| Rate for Payer: Preferred Network Access Commercial |
$19,479.49
|
| Rate for Payer: Quartz Beloit One Network |
$10,374.95
|
| Rate for Payer: Quartz Commercial |
$13,762.68
|
| Rate for Payer: Quartz Medicare Advantage |
$12,704.02
|
| Rate for Payer: The Alliance Commercial |
$10,586.68
|
| Rate for Payer: WEA Trust Commercial |
$11,645.35
|
| Rate for Payer: WPS Commercial |
$15,682.54
|
|
|
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 |
$10,374.95 |
| Max. Negotiated Rate |
$19,479.49 |
| Rate for Payer: Aetna Commercial |
$19,056.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,209.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,221.88
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$19,479.49
|
| Rate for Payer: Health EOS Commercial |
$18,844.29
|
| Rate for Payer: HFN Commercial |
$19,479.49
|
| Rate for Payer: Multiplan Commercial |
$16,938.69
|
| Rate for Payer: Preferred Network Access Commercial |
$19,479.49
|
| Rate for Payer: Quartz Beloit One Network |
$10,374.95
|
| Rate for Payer: Quartz Commercial |
$12,704.02
|
| Rate for Payer: WEA Trust Commercial |
$11,645.35
|
| Rate for Payer: WPS Commercial |
$15,682.54
|
|
|
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 |
$5,928.54 |
| Max. Negotiated Rate |
$19,479.49 |
| Rate for Payer: Aetna Commercial |
$19,056.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,209.09
|
| Rate for Payer: Aetna Managed Medicare |
$5,928.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,762.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,586.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,163.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,221.88
|
| Rate for Payer: Cash Price |
$6,107.70
|
| Rate for Payer: Cigna Commercial |
$19,479.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,848.94
|
| Rate for Payer: Health EOS Commercial |
$18,844.29
|
| Rate for Payer: HFN Commercial |
$19,479.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,880.02
|
| Rate for Payer: Multiplan Commercial |
$16,938.69
|
| Rate for Payer: NAPHCARE Commercial |
$12,704.02
|
| Rate for Payer: Preferred Network Access Commercial |
$19,479.49
|
| Rate for Payer: Quartz Beloit One Network |
$10,374.95
|
| Rate for Payer: Quartz Commercial |
$13,762.68
|
| Rate for Payer: Quartz Medicare Advantage |
$12,704.02
|
| Rate for Payer: The Alliance Commercial |
$10,586.68
|
| Rate for Payer: WEA Trust Commercial |
$11,645.35
|
| Rate for Payer: WPS Commercial |
$15,682.54
|
|
|
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 |
$2,383.47 |
| Max. Negotiated Rate |
$7,831.41 |
| Rate for Payer: Aetna Commercial |
$7,661.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,320.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,383.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,533.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,256.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,085.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,511.57
|
| Rate for Payer: Cash Price |
$2,455.50
|
| Rate for Payer: Cigna Commercial |
$7,831.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,763.67
|
| Rate for Payer: Health EOS Commercial |
$7,576.04
|
| Rate for Payer: HFN Commercial |
$7,831.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,384.30
|
| Rate for Payer: Multiplan Commercial |
$6,809.92
|
| Rate for Payer: NAPHCARE Commercial |
$5,107.44
|
| Rate for Payer: Preferred Network Access Commercial |
$7,831.41
|
| Rate for Payer: Quartz Beloit One Network |
$4,171.08
|
| Rate for Payer: Quartz Commercial |
$5,533.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,107.44
|
| Rate for Payer: The Alliance Commercial |
$4,256.20
|
| Rate for Payer: WEA Trust Commercial |
$4,681.82
|
| Rate for Payer: WPS Commercial |
$6,304.91
|
|
|
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 |
$4,171.08 |
| Max. Negotiated Rate |
$7,831.41 |
| Rate for Payer: Aetna Commercial |
$7,661.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,320.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,511.57
|
| Rate for Payer: Cash Price |
$2,455.50
|
| Rate for Payer: Cigna Commercial |
$7,831.41
|
| Rate for Payer: Health EOS Commercial |
$7,576.04
|
| Rate for Payer: HFN Commercial |
$7,831.41
|
| Rate for Payer: Multiplan Commercial |
$6,809.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,831.41
|
| Rate for Payer: Quartz Beloit One Network |
$4,171.08
|
| Rate for Payer: Quartz Commercial |
$5,107.44
|
| Rate for Payer: WEA Trust Commercial |
$4,681.82
|
| Rate for Payer: WPS Commercial |
$6,304.91
|
|
|
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 |
$94.35 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$94.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$161.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.57
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.72
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$202.18
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$219.02
|
| Rate for Payer: Quartz Medicare Advantage |
$202.18
|
| Rate for Payer: The Alliance Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
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 |
$165.11 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$202.18
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
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 |
$1,306.61 |
| Max. Negotiated Rate |
$2,453.24 |
| Rate for Payer: Aetna Commercial |
$2,399.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,293.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,413.28
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,453.24
|
| Rate for Payer: Health EOS Commercial |
$2,373.24
|
| Rate for Payer: HFN Commercial |
$2,453.24
|
| Rate for Payer: Multiplan Commercial |
$2,133.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,453.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.61
|
| Rate for Payer: Quartz Commercial |
$1,599.94
|
| Rate for Payer: WEA Trust Commercial |
$1,466.61
|
| Rate for Payer: WPS Commercial |
$1,975.05
|
|
|
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 |
$746.64 |
| Max. Negotiated Rate |
$2,453.24 |
| Rate for Payer: Aetna Commercial |
$2,399.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,293.24
|
| Rate for Payer: Aetna Managed Medicare |
$746.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,733.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,333.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,413.28
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,453.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,492.25
|
| Rate for Payer: Health EOS Commercial |
$2,373.24
|
| Rate for Payer: HFN Commercial |
$2,453.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.92
|
| Rate for Payer: Multiplan Commercial |
$2,133.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,453.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.61
|
| Rate for Payer: Quartz Commercial |
$1,733.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.94
|
| Rate for Payer: The Alliance Commercial |
$1,333.28
|
| Rate for Payer: WEA Trust Commercial |
$1,466.61
|
| Rate for Payer: WPS Commercial |
$1,975.05
|
|
|
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 |
$1,356.05 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,660.46
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
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 |
$774.88 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Aetna Managed Medicare |
$774.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,328.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.70
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,075.58
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,660.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,798.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,660.46
|
| Rate for Payer: The Alliance Commercial |
$1,383.72
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
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 |
$1,306.61 |
| Max. Negotiated Rate |
$2,453.24 |
| Rate for Payer: Aetna Commercial |
$2,399.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,293.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,413.28
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,453.24
|
| Rate for Payer: Health EOS Commercial |
$2,373.24
|
| Rate for Payer: HFN Commercial |
$2,453.24
|
| Rate for Payer: Multiplan Commercial |
$2,133.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,453.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.61
|
| Rate for Payer: Quartz Commercial |
$1,599.94
|
| Rate for Payer: WEA Trust Commercial |
$1,466.61
|
| Rate for Payer: WPS Commercial |
$1,975.05
|
|
|
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 |
$746.64 |
| Max. Negotiated Rate |
$2,453.24 |
| Rate for Payer: Aetna Commercial |
$2,399.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,293.24
|
| Rate for Payer: Aetna Managed Medicare |
$746.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,733.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,333.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,413.28
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,453.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,492.25
|
| Rate for Payer: Health EOS Commercial |
$2,373.24
|
| Rate for Payer: HFN Commercial |
$2,453.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.92
|
| Rate for Payer: Multiplan Commercial |
$2,133.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,453.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.61
|
| Rate for Payer: Quartz Commercial |
$1,733.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.94
|
| Rate for Payer: The Alliance Commercial |
$1,333.28
|
| Rate for Payer: WEA Trust Commercial |
$1,466.61
|
| Rate for Payer: WPS Commercial |
$1,975.05
|
|
|
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 |
$774.88 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Aetna Managed Medicare |
$774.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,328.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.70
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,075.58
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,660.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,798.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,660.46
|
| Rate for Payer: The Alliance Commercial |
$1,383.72
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
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 |
$1,356.05 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,660.46
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
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 |
$484.56 |
| Max. Negotiated Rate |
$1,592.12 |
| Rate for Payer: Aetna Commercial |
$1,557.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.28
|
| Rate for Payer: Aetna Managed Medicare |
$484.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,124.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$865.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$830.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,592.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$968.45
|
| Rate for Payer: Health EOS Commercial |
$1,540.20
|
| Rate for Payer: HFN Commercial |
$1,592.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,297.92
|
| Rate for Payer: Multiplan Commercial |
$1,384.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.12
|
| Rate for Payer: Quartz Beloit One Network |
$847.97
|
| Rate for Payer: Quartz Commercial |
$1,124.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,038.34
|
| Rate for Payer: The Alliance Commercial |
$865.28
|
| Rate for Payer: WEA Trust Commercial |
$951.81
|
| Rate for Payer: WPS Commercial |
$1,281.78
|
|
|
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 |
$847.97 |
| Max. Negotiated Rate |
$1,592.12 |
| Rate for Payer: Aetna Commercial |
$1,557.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,592.12
|
| Rate for Payer: Health EOS Commercial |
$1,540.20
|
| Rate for Payer: HFN Commercial |
$1,592.12
|
| Rate for Payer: Multiplan Commercial |
$1,384.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.12
|
| Rate for Payer: Quartz Beloit One Network |
$847.97
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: WEA Trust Commercial |
$951.81
|
| Rate for Payer: WPS Commercial |
$1,281.78
|
|
|
Ca Channel Bind Antibody SN Type
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$18.43
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
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 |
$12.53 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
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 |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
CA Channel Bind Antibody SP/Q Type
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
2942960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$18.43
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
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 |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
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 |
$12.53 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
CAD for Screening Mammography
|
Professional
|
Both
|
$82.00
|
|
| Hospital Charge Code |
1158804
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.17
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: The Alliance Commercial |
$42.64
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
