|
LINER 36X64 10DEG LONGEVITY 6305-64-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X64 10DEG LONGEVITY 6305-64-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36 X 64 CONTIMUUM ELEV 00-8752-016-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36 X 64 CONTIMUUM ELEV 00-8752-016-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X66 10DEG LONGEVITY 6305-66-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X66 10DEG LONGEVITY 6305-66-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36 X 66 CONTINUUM ELEV 00-8752-017-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36 X 66 CONTINUUM ELEV 00-8752-017-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X68 10DEG LONGEVITY 6305-68-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X68 10DEG LONGEVITY 6305-68-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36 X 68 CONTINUUM ELEV 00-8752-018-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36 X 68 CONTINUUM ELEV 00-8752-018-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X70 10DEG LONGEVITY 6305-70-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X70 10DEG LONGEVITY 6305-70-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 47/48/49 BIPOLAR CUP 00-5001-047-28
|
Facility
|
OP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.88 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Aetna Managed Medicare |
$903.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,098.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,614.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,549.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.53
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,421.12
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$2,098.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,936.90
|
| Rate for Payer: The Alliance Commercial |
$1,614.08
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
LINER 47/48/49 BIPOLAR CUP 00-5001-047-28
|
Facility
|
IP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.80 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$1,936.90
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
LINER 48X28 LONGEV. 6310-48-28
|
Facility
|
IP
|
$8,851.00
|
|
| Hospital Charge Code |
2967726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.47 |
| Max. Negotiated Rate |
$8,468.64 |
| Rate for Payer: Aetna Commercial |
$8,284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.67
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,468.64
|
| Rate for Payer: Health EOS Commercial |
$8,192.49
|
| Rate for Payer: HFN Commercial |
$8,468.64
|
| Rate for Payer: Multiplan Commercial |
$7,364.03
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.47
|
| Rate for Payer: Quartz Commercial |
$5,523.02
|
| Rate for Payer: WEA Trust Commercial |
$5,062.77
|
| Rate for Payer: WPS Commercial |
$6,817.93
|
|
|
LINER 48X28 LONGEV. 6310-48-28
|
Facility
|
OP
|
$8,851.00
|
|
| Hospital Charge Code |
2967726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.41 |
| Max. Negotiated Rate |
$8,468.64 |
| Rate for Payer: Aetna Commercial |
$8,284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.33
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,602.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.67
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,468.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.28
|
| Rate for Payer: Health EOS Commercial |
$8,192.49
|
| Rate for Payer: HFN Commercial |
$8,468.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,903.78
|
| Rate for Payer: Multiplan Commercial |
$7,364.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.02
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.47
|
| Rate for Payer: Quartz Commercial |
$5,983.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.02
|
| Rate for Payer: The Alliance Commercial |
$4,602.52
|
| Rate for Payer: WEA Trust Commercial |
$5,062.77
|
| Rate for Payer: WPS Commercial |
$6,817.93
|
|
|
LINER 48X32 LONGEVITY 10 DEG 6310-48-32
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER 48X32 LONGEVITY 10 DEG 6310-48-32
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER 50/51/52 BIPOLAR CUP 5001-50-28
|
Facility
|
IP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.80 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$1,936.90
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
LINER 50/51/52 BIPOLAR CUP 5001-50-28
|
Facility
|
OP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.88 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Aetna Managed Medicare |
$903.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,098.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,614.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,549.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.53
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,421.12
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$2,098.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,936.90
|
| Rate for Payer: The Alliance Commercial |
$1,614.08
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
LINER 50 X 32 CONTINUUM ELEV 00-8752-009-32
|
Facility
|
OP
|
$8,851.00
|
|
| Hospital Charge Code |
2967730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.41 |
| Max. Negotiated Rate |
$8,468.64 |
| Rate for Payer: Aetna Commercial |
$8,284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.33
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,602.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.67
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,468.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.28
|
| Rate for Payer: Health EOS Commercial |
$8,192.49
|
| Rate for Payer: HFN Commercial |
$8,468.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,903.78
|
| Rate for Payer: Multiplan Commercial |
$7,364.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.02
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.47
|
| Rate for Payer: Quartz Commercial |
$5,983.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.02
|
| Rate for Payer: The Alliance Commercial |
$4,602.52
|
| Rate for Payer: WEA Trust Commercial |
$5,062.77
|
| Rate for Payer: WPS Commercial |
$6,817.93
|
|
|
LINER 50 X 32 CONTINUUM ELEV 00-8752-009-32
|
Facility
|
IP
|
$8,851.00
|
|
| Hospital Charge Code |
2967730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.47 |
| Max. Negotiated Rate |
$8,468.64 |
| Rate for Payer: Aetna Commercial |
$8,284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.67
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,468.64
|
| Rate for Payer: Health EOS Commercial |
$8,192.49
|
| Rate for Payer: HFN Commercial |
$8,468.64
|
| Rate for Payer: Multiplan Commercial |
$7,364.03
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.47
|
| Rate for Payer: Quartz Commercial |
$5,523.02
|
| Rate for Payer: WEA Trust Commercial |
$5,062.77
|
| Rate for Payer: WPS Commercial |
$6,817.93
|
|
|
LINER 50X32 LONGEVITY 10 DEG 6310-50-32
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
