|
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
|
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 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 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: The Alliance Commercial |
$4,602.52
|
| 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: 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
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967731
|
|
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 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
|
|
|
LINER 52 X 32 CONTINUUM ELEV 00-8752-010-32
|
Facility
|
OP
|
$9,192.00
|
|
| Hospital Charge Code |
2967732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.71 |
| Max. Negotiated Rate |
$8,794.91 |
| Rate for Payer: Aetna Commercial |
$8,603.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,221.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,676.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,213.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,779.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,588.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,066.63
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cigna Commercial |
$8,794.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,349.74
|
| Rate for Payer: Health EOS Commercial |
$8,508.12
|
| Rate for Payer: HFN Commercial |
$8,794.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,169.76
|
| Rate for Payer: Multiplan Commercial |
$7,647.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,735.81
|
| Rate for Payer: Preferred Network Access Commercial |
$8,794.91
|
| Rate for Payer: Quartz Beloit One Network |
$4,684.24
|
| Rate for Payer: Quartz Commercial |
$6,213.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,735.81
|
| Rate for Payer: The Alliance Commercial |
$4,779.84
|
| Rate for Payer: WEA Trust Commercial |
$5,257.82
|
| Rate for Payer: WPS Commercial |
$7,080.60
|
|
|
LINER 52 X 32 CONTINUUM ELEV 00-8752-010-32
|
Facility
|
IP
|
$9,192.00
|
|
| Hospital Charge Code |
2967732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,684.24 |
| Max. Negotiated Rate |
$8,794.91 |
| Rate for Payer: Aetna Commercial |
$8,603.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,221.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,066.63
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cigna Commercial |
$8,794.91
|
| Rate for Payer: Health EOS Commercial |
$8,508.12
|
| Rate for Payer: HFN Commercial |
$8,794.91
|
| Rate for Payer: Multiplan Commercial |
$7,647.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,794.91
|
| Rate for Payer: Quartz Beloit One Network |
$4,684.24
|
| Rate for Payer: Quartz Commercial |
$5,735.81
|
| Rate for Payer: WEA Trust Commercial |
$5,257.82
|
| Rate for Payer: WPS Commercial |
$7,080.60
|
|
|
LINER 52 X 36 CONTINUUM ELEV 00-8752-010-36
|
Facility
|
OP
|
$10,355.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967733
|
|
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 52 X 36 CONTINUUM ELEV 00-8752-010-36
|
Facility
|
IP
|
$10,355.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967733
|
|
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 53/54/55 BIPOLAR CUP 5001-053-28
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967734
|
|
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
|
|
