|
LINER 60 X 36 CONTINUUM ELEV 00-8752-014-36
|
Facility
|
OP
|
$10,355.00
|
|
| Hospital Charge Code |
2967745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.40 |
| Max. Negotiated Rate |
$41,420.00 |
| Rate for Payer: Aetna Commercial |
$9,319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,905.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,899.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,730.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,970.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,488.15
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,526.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,794.66
|
| Rate for Payer: Health EOS Commercial |
$9,215.95
|
| Rate for Payer: HFN Commercial |
$9,526.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,766.25
|
| Rate for Payer: Multiplan Commercial |
$8,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,526.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.95
|
| Rate for Payer: Quartz Commercial |
$6,730.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,213.00
|
| Rate for Payer: The Alliance Commercial |
$41,420.00
|
| Rate for Payer: WEA Trust Commercial |
$5,695.25
|
| Rate for Payer: WPS Commercial |
$7,669.95
|
|
|
LINER 60 X 36 CONTINUUM ELEV 00-8752-014-36
|
Facility
|
IP
|
$10,355.00
|
|
| Hospital Charge Code |
2967745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,073.95 |
| Max. Negotiated Rate |
$9,526.60 |
| Rate for Payer: Aetna Commercial |
$9,319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,905.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,488.15
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,526.60
|
| Rate for Payer: Health EOS Commercial |
$9,215.95
|
| Rate for Payer: HFN Commercial |
$9,526.60
|
| Rate for Payer: Multiplan Commercial |
$8,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,526.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.95
|
| Rate for Payer: Quartz Commercial |
$6,213.00
|
| Rate for Payer: WEA Trust Commercial |
$5,695.25
|
| Rate for Payer: WPS Commercial |
$7,669.95
|
|
|
LINER 62X32 10DEG 6310-62-32
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
LINER 62X32 10DEG 6310-62-32
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
LINER 62 X 32 CONTINUUM ELEV 00-8752-015-32
|
Facility
|
OP
|
$8,851.00
|
|
| Hospital Charge Code |
2967746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,478.28 |
| Max. Negotiated Rate |
$35,404.00 |
| Rate for Payer: Aetna Commercial |
$7,965.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,611.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,478.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,753.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,248.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,691.03
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,142.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,953.02
|
| Rate for Payer: Health EOS Commercial |
$7,877.39
|
| Rate for Payer: HFN Commercial |
$8,142.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,638.25
|
| Rate for Payer: Multiplan Commercial |
$7,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,310.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,142.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,336.99
|
| Rate for Payer: Quartz Commercial |
$5,753.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,310.60
|
| Rate for Payer: The Alliance Commercial |
$35,404.00
|
| Rate for Payer: WEA Trust Commercial |
$4,868.05
|
| Rate for Payer: WPS Commercial |
$6,555.94
|
|
|
LINER 62 X 32 CONTINUUM ELEV 00-8752-015-32
|
Facility
|
IP
|
$8,851.00
|
|
| Hospital Charge Code |
2967746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.99 |
| Max. Negotiated Rate |
$8,142.92 |
| Rate for Payer: Aetna Commercial |
$7,965.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,611.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,691.03
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,142.92
|
| Rate for Payer: Health EOS Commercial |
$7,877.39
|
| Rate for Payer: HFN Commercial |
$8,142.92
|
| Rate for Payer: Multiplan Commercial |
$7,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,310.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,142.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,336.99
|
| Rate for Payer: Quartz Commercial |
$5,310.60
|
| Rate for Payer: WEA Trust Commercial |
$4,868.05
|
| Rate for Payer: WPS Commercial |
$6,555.94
|
|
|
LINER 62 X 36 CONTINUUM ELEV 00-8752-015-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,886.77 |
| Max. Negotiated Rate |
$9,175.16 |
| Rate for Payer: Aetna Commercial |
$8,975.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,576.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,285.69
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,175.16
|
| Rate for Payer: Health EOS Commercial |
$8,875.97
|
| Rate for Payer: HFN Commercial |
$9,175.16
|
| Rate for Payer: Multiplan Commercial |
$7,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,983.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,175.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,886.77
|
| Rate for Payer: Quartz Commercial |
$5,983.80
|
| Rate for Payer: WEA Trust Commercial |
$5,485.15
|
| Rate for Payer: WPS Commercial |
$7,387.00
|
|
|
LINER 62 X 36 CONTINUUM ELEV 00-8752-015-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.44 |
| Max. Negotiated Rate |
$39,892.00 |
| Rate for Payer: Aetna Commercial |
$8,975.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,576.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,792.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,482.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,986.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,787.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,285.69
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,175.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,580.89
|
| Rate for Payer: Health EOS Commercial |
$8,875.97
|
| Rate for Payer: HFN Commercial |
$9,175.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,479.75
|
| Rate for Payer: Multiplan Commercial |
$7,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,983.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,175.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,886.77
|
| Rate for Payer: Quartz Commercial |
$6,482.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,983.80
|
| Rate for Payer: The Alliance Commercial |
$39,892.00
|
| Rate for Payer: WEA Trust Commercial |
$5,485.15
|
| Rate for Payer: WPS Commercial |
$7,387.00
|
|
|
LINER BIPOLAR 40/41 5001-40-22
|
Facility
|
OP
|
$2,990.00
|
|
| Hospital Charge Code |
2969402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.20 |
| Max. Negotiated Rate |
$11,960.00 |
| Rate for Payer: Aetna Commercial |
$2,691.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,571.40
|
| Rate for Payer: Aetna Managed Medicare |
$837.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,943.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,495.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,435.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,584.70
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,750.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,673.20
|
| Rate for Payer: Health EOS Commercial |
$2,661.10
|
| Rate for Payer: HFN Commercial |
$2,750.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,242.50
|
| Rate for Payer: Multiplan Commercial |
$2,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,794.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,750.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.10
|
| Rate for Payer: Quartz Commercial |
$1,943.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,794.00
|
| Rate for Payer: The Alliance Commercial |
$11,960.00
|
| Rate for Payer: WEA Trust Commercial |
$1,644.50
|
| Rate for Payer: WPS Commercial |
$2,214.69
|
|
|
LINER BIPOLAR 40/41 5001-40-22
|
Facility
|
IP
|
$2,990.00
|
|
| Hospital Charge Code |
2969402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,465.10 |
| Max. Negotiated Rate |
$2,750.80 |
| Rate for Payer: Aetna Commercial |
$2,691.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,571.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,584.70
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,750.80
|
| Rate for Payer: Health EOS Commercial |
$2,661.10
|
| Rate for Payer: HFN Commercial |
$2,750.80
|
| Rate for Payer: Multiplan Commercial |
$2,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,794.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,750.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.10
|
| Rate for Payer: Quartz Commercial |
$1,794.00
|
| Rate for Payer: WEA Trust Commercial |
$1,644.50
|
| Rate for Payer: WPS Commercial |
$2,214.69
|
|
|
LINER BIPOLAR 42/43 5001-42-22
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,465.10 |
| Max. Negotiated Rate |
$2,750.80 |
| Rate for Payer: Aetna Commercial |
$2,691.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,571.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,584.70
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,750.80
|
| Rate for Payer: Health EOS Commercial |
$2,661.10
|
| Rate for Payer: HFN Commercial |
$2,750.80
|
| Rate for Payer: Multiplan Commercial |
$2,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,794.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,750.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.10
|
| Rate for Payer: Quartz Commercial |
$1,794.00
|
| Rate for Payer: WEA Trust Commercial |
$1,644.50
|
| Rate for Payer: WPS Commercial |
$2,214.69
|
|
|
LINER BIPOLAR 42/43 5001-42-22
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.20 |
| Max. Negotiated Rate |
$11,960.00 |
| Rate for Payer: Aetna Commercial |
$2,691.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,571.40
|
| Rate for Payer: Aetna Managed Medicare |
$837.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,943.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,495.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,435.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,584.70
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,750.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,673.20
|
| Rate for Payer: Health EOS Commercial |
$2,661.10
|
| Rate for Payer: HFN Commercial |
$2,750.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,242.50
|
| Rate for Payer: Multiplan Commercial |
$2,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,794.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,750.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.10
|
| Rate for Payer: Quartz Commercial |
$1,943.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,794.00
|
| Rate for Payer: The Alliance Commercial |
$11,960.00
|
| Rate for Payer: WEA Trust Commercial |
$1,644.50
|
| Rate for Payer: WPS Commercial |
$2,214.69
|
|
|
LINER BIPOLAR 44MM X 22MM 00-5001-044-22
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4281946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,549.80 |
| Max. Negotiated Rate |
$22,140.00 |
| Rate for Payer: Aetna Commercial |
$4,981.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,760.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,549.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,597.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,767.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,656.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,933.55
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$5,092.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,097.39
|
| Rate for Payer: Health EOS Commercial |
$4,926.15
|
| Rate for Payer: HFN Commercial |
$5,092.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,151.25
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,092.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,712.15
|
| Rate for Payer: Quartz Commercial |
$3,597.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,321.00
|
| Rate for Payer: The Alliance Commercial |
$22,140.00
|
| Rate for Payer: WEA Trust Commercial |
$3,044.25
|
| Rate for Payer: WPS Commercial |
$4,099.77
|
|
|
LINER BIPOLAR 44MM X 22MM 00-5001-044-22
|
Facility
|
IP
|
$5,535.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4281946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.15 |
| Max. Negotiated Rate |
$5,092.20 |
| Rate for Payer: Aetna Commercial |
$4,981.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,760.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,933.55
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$5,092.20
|
| Rate for Payer: Health EOS Commercial |
$4,926.15
|
| Rate for Payer: HFN Commercial |
$5,092.20
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,092.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,712.15
|
| Rate for Payer: Quartz Commercial |
$3,321.00
|
| Rate for Payer: WEA Trust Commercial |
$3,044.25
|
| Rate for Payer: WPS Commercial |
$4,099.77
|
|
|
LINER CONTINUUM 56 X 36 KK ELEV RIM 00-8752-012-36
|
Facility
|
OP
|
$10,355.00
|
|
| Hospital Charge Code |
2967739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.40 |
| Max. Negotiated Rate |
$41,420.00 |
| Rate for Payer: Aetna Commercial |
$9,319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,905.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,899.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,730.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,970.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,488.15
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,526.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,794.66
|
| Rate for Payer: Health EOS Commercial |
$9,215.95
|
| Rate for Payer: HFN Commercial |
$9,526.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,766.25
|
| Rate for Payer: Multiplan Commercial |
$8,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,526.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.95
|
| Rate for Payer: Quartz Commercial |
$6,730.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,213.00
|
| Rate for Payer: The Alliance Commercial |
$41,420.00
|
| Rate for Payer: WEA Trust Commercial |
$5,695.25
|
| Rate for Payer: WPS Commercial |
$7,669.95
|
|
|
LINER CONTINUUM 56 X 36 KK ELEV RIM 00-8752-012-36
|
Facility
|
IP
|
$10,355.00
|
|
| Hospital Charge Code |
2967739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,073.95 |
| Max. Negotiated Rate |
$9,526.60 |
| Rate for Payer: Aetna Commercial |
$9,319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,905.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,488.15
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,526.60
|
| Rate for Payer: Health EOS Commercial |
$9,215.95
|
| Rate for Payer: HFN Commercial |
$9,526.60
|
| Rate for Payer: Multiplan Commercial |
$8,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,526.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.95
|
| Rate for Payer: Quartz Commercial |
$6,213.00
|
| Rate for Payer: WEA Trust Commercial |
$5,695.25
|
| Rate for Payer: WPS Commercial |
$7,669.95
|
|
|
LINER CONTINUUM 58 X 36 LL ELEV RIM 00-8752-013-36
|
Facility
|
IP
|
$10,355.00
|
|
| Hospital Charge Code |
2967742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,073.95 |
| Max. Negotiated Rate |
$9,526.60 |
| Rate for Payer: Aetna Commercial |
$9,319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,905.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,488.15
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,526.60
|
| Rate for Payer: Health EOS Commercial |
$9,215.95
|
| Rate for Payer: HFN Commercial |
$9,526.60
|
| Rate for Payer: Multiplan Commercial |
$8,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,526.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.95
|
| Rate for Payer: Quartz Commercial |
$6,213.00
|
| Rate for Payer: WEA Trust Commercial |
$5,695.25
|
| Rate for Payer: WPS Commercial |
$7,669.95
|
|
|
LINER CONTINUUM 58 X 36 LL ELEV RIM 00-8752-013-36
|
Facility
|
OP
|
$10,355.00
|
|
| Hospital Charge Code |
2967742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.40 |
| Max. Negotiated Rate |
$41,420.00 |
| Rate for Payer: Aetna Commercial |
$9,319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,905.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,899.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,730.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,970.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,488.15
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,526.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,794.66
|
| Rate for Payer: Health EOS Commercial |
$9,215.95
|
| Rate for Payer: HFN Commercial |
$9,526.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,766.25
|
| Rate for Payer: Multiplan Commercial |
$8,284.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,526.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.95
|
| Rate for Payer: Quartz Commercial |
$6,730.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,213.00
|
| Rate for Payer: The Alliance Commercial |
$41,420.00
|
| Rate for Payer: WEA Trust Commercial |
$5,695.25
|
| Rate for Payer: WPS Commercial |
$7,669.95
|
|
|
LINER CONTINUUM 7MM OFFSET 36 X 54 00-8754-011-36
|
Facility
|
OP
|
$8,826.00
|
|
| Hospital Charge Code |
4366019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.28 |
| Max. Negotiated Rate |
$35,304.00 |
| Rate for Payer: Aetna Commercial |
$7,943.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,590.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,471.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,736.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,236.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,677.78
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,119.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,939.03
|
| Rate for Payer: Health EOS Commercial |
$7,855.14
|
| Rate for Payer: HFN Commercial |
$8,119.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,619.50
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,295.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,119.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,324.74
|
| Rate for Payer: Quartz Commercial |
$5,736.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,295.60
|
| Rate for Payer: The Alliance Commercial |
$35,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,854.30
|
| Rate for Payer: WPS Commercial |
$6,537.42
|
|
|
LINER CONTINUUM 7MM OFFSET 36 X 54 00-8754-011-36
|
Facility
|
IP
|
$8,826.00
|
|
| Hospital Charge Code |
4366019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,324.74 |
| Max. Negotiated Rate |
$8,119.92 |
| Rate for Payer: Aetna Commercial |
$7,943.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,590.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,677.78
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,119.92
|
| Rate for Payer: Health EOS Commercial |
$7,855.14
|
| Rate for Payer: HFN Commercial |
$8,119.92
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,295.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,119.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,324.74
|
| Rate for Payer: Quartz Commercial |
$5,295.60
|
| Rate for Payer: WEA Trust Commercial |
$4,854.30
|
| Rate for Payer: WPS Commercial |
$6,537.42
|
|
|
LINER CONTINUUM ELEV 48 X 32 00-8752-008-32
|
Facility
|
OP
|
$8,851.00
|
|
| Hospital Charge Code |
2967727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,478.28 |
| Max. Negotiated Rate |
$35,404.00 |
| Rate for Payer: Aetna Commercial |
$7,965.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,611.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,478.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,753.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,248.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,691.03
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,142.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,953.02
|
| Rate for Payer: Health EOS Commercial |
$7,877.39
|
| Rate for Payer: HFN Commercial |
$8,142.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,638.25
|
| Rate for Payer: Multiplan Commercial |
$7,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,310.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,142.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,336.99
|
| Rate for Payer: Quartz Commercial |
$5,753.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,310.60
|
| Rate for Payer: The Alliance Commercial |
$35,404.00
|
| Rate for Payer: WEA Trust Commercial |
$4,868.05
|
| Rate for Payer: WPS Commercial |
$6,555.94
|
|
|
LINER CONTINUUM ELEV 48 X 32 00-8752-008-32
|
Facility
|
IP
|
$8,851.00
|
|
| Hospital Charge Code |
2967727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.99 |
| Max. Negotiated Rate |
$8,142.92 |
| Rate for Payer: Aetna Commercial |
$7,965.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,611.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,691.03
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,142.92
|
| Rate for Payer: Health EOS Commercial |
$7,877.39
|
| Rate for Payer: HFN Commercial |
$8,142.92
|
| Rate for Payer: Multiplan Commercial |
$7,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,310.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,142.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,336.99
|
| Rate for Payer: Quartz Commercial |
$5,310.60
|
| Rate for Payer: WEA Trust Commercial |
$4,868.05
|
| Rate for Payer: WPS Commercial |
$6,555.94
|
|
|
LINER CONTINUUM LONGEVITY 7MM OFFSET 36MM X 52MM 00-8754-010-36
|
Facility
|
OP
|
$8,826.00
|
|
| Hospital Charge Code |
3825393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.28 |
| Max. Negotiated Rate |
$35,304.00 |
| Rate for Payer: Aetna Commercial |
$7,943.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,590.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,471.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,736.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,236.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,677.78
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,119.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,939.03
|
| Rate for Payer: Health EOS Commercial |
$7,855.14
|
| Rate for Payer: HFN Commercial |
$8,119.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,619.50
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,295.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,119.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,324.74
|
| Rate for Payer: Quartz Commercial |
$5,736.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,295.60
|
| Rate for Payer: The Alliance Commercial |
$35,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,854.30
|
| Rate for Payer: WPS Commercial |
$6,537.42
|
|
|
LINER CONTINUUM LONGEVITY 7MM OFFSET 36MM X 52MM 00-8754-010-36
|
Facility
|
IP
|
$8,826.00
|
|
| Hospital Charge Code |
3825393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,324.74 |
| Max. Negotiated Rate |
$8,119.92 |
| Rate for Payer: Aetna Commercial |
$7,943.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,590.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,677.78
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,119.92
|
| Rate for Payer: Health EOS Commercial |
$7,855.14
|
| Rate for Payer: HFN Commercial |
$8,119.92
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,295.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,119.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,324.74
|
| Rate for Payer: Quartz Commercial |
$5,295.60
|
| Rate for Payer: WEA Trust Commercial |
$4,854.30
|
| Rate for Payer: WPS Commercial |
$6,537.42
|
|
|
LINER CONTINUUM LONGEVITY 7MM OFFSET 36MM X 58MM 00-8754-013-36
|
Facility
|
OP
|
$8,826.00
|
|
| Hospital Charge Code |
3825394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,471.28 |
| Max. Negotiated Rate |
$35,304.00 |
| Rate for Payer: Aetna Commercial |
$7,943.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,590.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,471.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,736.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,236.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,677.78
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,119.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,939.03
|
| Rate for Payer: Health EOS Commercial |
$7,855.14
|
| Rate for Payer: HFN Commercial |
$8,119.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,619.50
|
| Rate for Payer: Multiplan Commercial |
$7,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,295.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,119.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,324.74
|
| Rate for Payer: Quartz Commercial |
$5,736.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,295.60
|
| Rate for Payer: The Alliance Commercial |
$35,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,854.30
|
| Rate for Payer: WPS Commercial |
$6,537.42
|
|
