|
LINER 60 X 32 CONTINUUM ELEV 00-8752-014-32
|
Facility
|
OP
|
$8,851.00
|
|
| Hospital Charge Code |
2967744
|
|
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 60 X 32 CONTINUUM ELEV 00-8752-014-32
|
Facility
|
IP
|
$8,851.00
|
|
| Hospital Charge Code |
2967744
|
|
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 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 |
$5,276.91 |
| Max. Negotiated Rate |
$9,907.66 |
| Rate for Payer: Aetna Commercial |
$9,692.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,261.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,707.68
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,907.66
|
| Rate for Payer: Health EOS Commercial |
$9,584.59
|
| Rate for Payer: HFN Commercial |
$9,907.66
|
| Rate for Payer: Multiplan Commercial |
$8,615.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,907.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,276.91
|
| Rate for Payer: Quartz Commercial |
$6,461.52
|
| Rate for Payer: WEA Trust Commercial |
$5,923.06
|
| Rate for Payer: WPS Commercial |
$7,976.46
|
|
|
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 |
$3,015.38 |
| Max. Negotiated Rate |
$9,907.66 |
| Rate for Payer: Aetna Commercial |
$9,692.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,261.51
|
| Rate for Payer: Aetna Managed Medicare |
$3,015.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,999.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,384.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,169.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,707.68
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,907.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,026.61
|
| Rate for Payer: Health EOS Commercial |
$9,584.59
|
| Rate for Payer: HFN Commercial |
$9,907.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,076.90
|
| Rate for Payer: Multiplan Commercial |
$8,615.36
|
| Rate for Payer: NAPHCARE Commercial |
$6,461.52
|
| Rate for Payer: Preferred Network Access Commercial |
$9,907.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,276.91
|
| Rate for Payer: Quartz Commercial |
$6,999.98
|
| Rate for Payer: Quartz Medicare Advantage |
$6,461.52
|
| Rate for Payer: The Alliance Commercial |
$5,384.60
|
| Rate for Payer: WEA Trust Commercial |
$5,923.06
|
| Rate for Payer: WPS Commercial |
$7,976.46
|
|
|
LINER 62X32 10DEG 6310-62-32
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967552
|
|
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 62X32 10DEG 6310-62-32
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967552
|
|
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 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 |
$2,577.41 |
| 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 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 |
$4,510.47 |
| 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 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 |
$2,904.14 |
| 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 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 |
$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 BIPOLAR 40/41 5001-40-22
|
Facility
|
OP
|
$2,990.00
|
|
| Hospital Charge Code |
2969402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.69 |
| Max. Negotiated Rate |
$2,860.83 |
| Rate for Payer: Aetna Commercial |
$2,798.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.26
|
| Rate for Payer: Aetna Managed Medicare |
$870.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,021.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,554.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,492.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.09
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,860.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.18
|
| Rate for Payer: Health EOS Commercial |
$2,767.54
|
| Rate for Payer: HFN Commercial |
$2,860.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,332.20
|
| Rate for Payer: Multiplan Commercial |
$2,487.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,865.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,860.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.70
|
| Rate for Payer: Quartz Commercial |
$2,021.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,865.76
|
| Rate for Payer: The Alliance Commercial |
$1,554.80
|
| Rate for Payer: WEA Trust Commercial |
$1,710.28
|
| Rate for Payer: WPS Commercial |
$2,303.20
|
|
|
LINER BIPOLAR 40/41 5001-40-22
|
Facility
|
IP
|
$2,990.00
|
|
| Hospital Charge Code |
2969402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.70 |
| Max. Negotiated Rate |
$2,860.83 |
| Rate for Payer: Aetna Commercial |
$2,798.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.09
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,860.83
|
| Rate for Payer: Health EOS Commercial |
$2,767.54
|
| Rate for Payer: HFN Commercial |
$2,860.83
|
| Rate for Payer: Multiplan Commercial |
$2,487.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,860.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.70
|
| Rate for Payer: Quartz Commercial |
$1,865.76
|
| Rate for Payer: WEA Trust Commercial |
$1,710.28
|
| Rate for Payer: WPS Commercial |
$2,303.20
|
|
|
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 |
$870.69 |
| Max. Negotiated Rate |
$2,860.83 |
| Rate for Payer: Aetna Commercial |
$2,798.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.26
|
| Rate for Payer: Aetna Managed Medicare |
$870.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,021.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,554.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,492.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.09
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,860.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.18
|
| Rate for Payer: Health EOS Commercial |
$2,767.54
|
| Rate for Payer: HFN Commercial |
$2,860.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,332.20
|
| Rate for Payer: Multiplan Commercial |
$2,487.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,865.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,860.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.70
|
| Rate for Payer: Quartz Commercial |
$2,021.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,865.76
|
| Rate for Payer: The Alliance Commercial |
$1,554.80
|
| Rate for Payer: WEA Trust Commercial |
$1,710.28
|
| Rate for Payer: WPS Commercial |
$2,303.20
|
|
|
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 |
$1,523.70 |
| Max. Negotiated Rate |
$2,860.83 |
| Rate for Payer: Aetna Commercial |
$2,798.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.09
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$2,860.83
|
| Rate for Payer: Health EOS Commercial |
$2,767.54
|
| Rate for Payer: HFN Commercial |
$2,860.83
|
| Rate for Payer: Multiplan Commercial |
$2,487.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,860.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.70
|
| Rate for Payer: Quartz Commercial |
$1,865.76
|
| Rate for Payer: WEA Trust Commercial |
$1,710.28
|
| Rate for Payer: WPS Commercial |
$2,303.20
|
|
|
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 |
$2,820.64 |
| Max. Negotiated Rate |
$5,295.89 |
| Rate for Payer: Aetna Commercial |
$5,180.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,950.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,050.89
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$5,295.89
|
| Rate for Payer: Health EOS Commercial |
$5,123.20
|
| Rate for Payer: HFN Commercial |
$5,295.89
|
| Rate for Payer: Multiplan Commercial |
$4,605.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,295.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,820.64
|
| Rate for Payer: Quartz Commercial |
$3,453.84
|
| Rate for Payer: WEA Trust Commercial |
$3,166.02
|
| Rate for Payer: WPS Commercial |
$4,263.61
|
|
|
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 |
$1,611.79 |
| Max. Negotiated Rate |
$5,295.89 |
| Rate for Payer: Aetna Commercial |
$5,180.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,950.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,611.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,741.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,878.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,763.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,050.89
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$5,295.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,221.37
|
| Rate for Payer: Health EOS Commercial |
$5,123.20
|
| Rate for Payer: HFN Commercial |
$5,295.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,317.30
|
| Rate for Payer: Multiplan Commercial |
$4,605.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,453.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,295.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,820.64
|
| Rate for Payer: Quartz Commercial |
$3,741.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3,453.84
|
| Rate for Payer: The Alliance Commercial |
$2,878.20
|
| Rate for Payer: WEA Trust Commercial |
$3,166.02
|
| Rate for Payer: WPS Commercial |
$4,263.61
|
|
|
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 |
$3,015.38 |
| Max. Negotiated Rate |
$9,907.66 |
| Rate for Payer: Aetna Commercial |
$9,692.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,261.51
|
| Rate for Payer: Aetna Managed Medicare |
$3,015.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,999.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,384.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,169.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,707.68
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,907.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,026.61
|
| Rate for Payer: Health EOS Commercial |
$9,584.59
|
| Rate for Payer: HFN Commercial |
$9,907.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,076.90
|
| Rate for Payer: Multiplan Commercial |
$8,615.36
|
| Rate for Payer: NAPHCARE Commercial |
$6,461.52
|
| Rate for Payer: Preferred Network Access Commercial |
$9,907.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,276.91
|
| Rate for Payer: Quartz Commercial |
$6,999.98
|
| Rate for Payer: Quartz Medicare Advantage |
$6,461.52
|
| Rate for Payer: The Alliance Commercial |
$5,384.60
|
| Rate for Payer: WEA Trust Commercial |
$5,923.06
|
| Rate for Payer: WPS Commercial |
$7,976.46
|
|
|
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 |
$5,276.91 |
| Max. Negotiated Rate |
$9,907.66 |
| Rate for Payer: Aetna Commercial |
$9,692.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,261.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,707.68
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,907.66
|
| Rate for Payer: Health EOS Commercial |
$9,584.59
|
| Rate for Payer: HFN Commercial |
$9,907.66
|
| Rate for Payer: Multiplan Commercial |
$8,615.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,907.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,276.91
|
| Rate for Payer: Quartz Commercial |
$6,461.52
|
| Rate for Payer: WEA Trust Commercial |
$5,923.06
|
| Rate for Payer: WPS Commercial |
$7,976.46
|
|
|
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 |
$3,015.38 |
| Max. Negotiated Rate |
$9,907.66 |
| Rate for Payer: Aetna Commercial |
$9,692.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,261.51
|
| Rate for Payer: Aetna Managed Medicare |
$3,015.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,999.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,384.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,169.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,707.68
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,907.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,026.61
|
| Rate for Payer: Health EOS Commercial |
$9,584.59
|
| Rate for Payer: HFN Commercial |
$9,907.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,076.90
|
| Rate for Payer: Multiplan Commercial |
$8,615.36
|
| Rate for Payer: NAPHCARE Commercial |
$6,461.52
|
| Rate for Payer: Preferred Network Access Commercial |
$9,907.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,276.91
|
| Rate for Payer: Quartz Commercial |
$6,999.98
|
| Rate for Payer: Quartz Medicare Advantage |
$6,461.52
|
| Rate for Payer: The Alliance Commercial |
$5,384.60
|
| Rate for Payer: WEA Trust Commercial |
$5,923.06
|
| Rate for Payer: WPS Commercial |
$7,976.46
|
|
|
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 |
$5,276.91 |
| Max. Negotiated Rate |
$9,907.66 |
| Rate for Payer: Aetna Commercial |
$9,692.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,261.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,707.68
|
| Rate for Payer: Cash Price |
$3,106.50
|
| Rate for Payer: Cigna Commercial |
$9,907.66
|
| Rate for Payer: Health EOS Commercial |
$9,584.59
|
| Rate for Payer: HFN Commercial |
$9,907.66
|
| Rate for Payer: Multiplan Commercial |
$8,615.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,907.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,276.91
|
| Rate for Payer: Quartz Commercial |
$6,461.52
|
| Rate for Payer: WEA Trust Commercial |
$5,923.06
|
| Rate for Payer: WPS Commercial |
$7,976.46
|
|
|
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 |
$2,570.13 |
| Max. Negotiated Rate |
$8,444.72 |
| Rate for Payer: Aetna Commercial |
$8,261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,893.97
|
| Rate for Payer: Aetna Managed Medicare |
$2,570.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,966.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,589.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,405.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,864.89
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,444.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,136.73
|
| Rate for Payer: Health EOS Commercial |
$8,169.35
|
| Rate for Payer: HFN Commercial |
$8,444.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,884.28
|
| Rate for Payer: Multiplan Commercial |
$7,343.23
|
| Rate for Payer: NAPHCARE Commercial |
$5,507.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,444.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,497.73
|
| Rate for Payer: Quartz Commercial |
$5,966.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,507.42
|
| Rate for Payer: The Alliance Commercial |
$4,589.52
|
| Rate for Payer: WEA Trust Commercial |
$5,048.47
|
| Rate for Payer: WPS Commercial |
$6,798.67
|
|
|
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 |
$4,497.73 |
| Max. Negotiated Rate |
$8,444.72 |
| Rate for Payer: Aetna Commercial |
$8,261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,893.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,864.89
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,444.72
|
| Rate for Payer: Health EOS Commercial |
$8,169.35
|
| Rate for Payer: HFN Commercial |
$8,444.72
|
| Rate for Payer: Multiplan Commercial |
$7,343.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,444.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,497.73
|
| Rate for Payer: Quartz Commercial |
$5,507.42
|
| Rate for Payer: WEA Trust Commercial |
$5,048.47
|
| Rate for Payer: WPS Commercial |
$6,798.67
|
|
|
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 |
$4,510.47 |
| 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 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 |
$2,577.41 |
| 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 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 |
$4,497.73 |
| Max. Negotiated Rate |
$8,444.72 |
| Rate for Payer: Aetna Commercial |
$8,261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,893.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,864.89
|
| Rate for Payer: Cash Price |
$2,647.80
|
| Rate for Payer: Cigna Commercial |
$8,444.72
|
| Rate for Payer: Health EOS Commercial |
$8,169.35
|
| Rate for Payer: HFN Commercial |
$8,444.72
|
| Rate for Payer: Multiplan Commercial |
$7,343.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,444.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,497.73
|
| Rate for Payer: Quartz Commercial |
$5,507.42
|
| Rate for Payer: WEA Trust Commercial |
$5,048.47
|
| Rate for Payer: WPS Commercial |
$6,798.67
|
|
