|
CLAMP DISPOSABLE PLASTIC
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
2972252
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.15
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
CLAMP DISPOSABLE PLASTIC
|
Facility
IP
|
$36.00
|
|
| Hospital Charge Code |
2972252
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
CLAMP HOFFMANN 3 10 HOLE 4921-2-060
|
Facility
OP
|
$4,575.00
|
|
| Hospital Charge Code |
5685709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,281.00 |
| Max. Negotiated Rate |
$18,300.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,934.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,281.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,973.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,196.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,560.17
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,431.25
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,973.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,745.00
|
| Rate for Payer: The Alliance Commercial |
$18,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
CLAMP HOFFMANN 3 10 HOLE 4921-2-060
|
Facility
IP
|
$4,575.00
|
|
| Hospital Charge Code |
5685709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,241.75 |
| Max. Negotiated Rate |
$4,209.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,745.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
CLAMP HOLDING 1.25MM 395.125
|
Facility
IP
|
$4,063.00
|
|
| Hospital Charge Code |
5771655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,990.87 |
| Max. Negotiated Rate |
$3,737.96 |
| Rate for Payer: Aetna Commercial |
$3,656.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.39
|
| Rate for Payer: Cash Price |
$1,218.90
|
| Rate for Payer: Cigna Commercial |
$3,737.96
|
| Rate for Payer: Health EOS Commercial |
$3,616.07
|
| Rate for Payer: HFN Commercial |
$3,737.96
|
| Rate for Payer: Multiplan Commercial |
$3,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,437.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,737.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,990.87
|
| Rate for Payer: Quartz Commercial |
$2,437.80
|
| Rate for Payer: WEA Trust Commercial |
$2,234.65
|
| Rate for Payer: WPS Commercial |
$3,009.46
|
|
|
CLAMP HOLDING 1.25MM 395.125
|
Facility
OP
|
$4,063.00
|
|
| Hospital Charge Code |
5771655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,137.64 |
| Max. Negotiated Rate |
$16,252.00 |
| Rate for Payer: Aetna Commercial |
$3,656.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,494.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,137.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,640.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,031.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,950.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.39
|
| Rate for Payer: Cash Price |
$1,218.90
|
| Rate for Payer: Cigna Commercial |
$3,737.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,273.65
|
| Rate for Payer: Health EOS Commercial |
$3,616.07
|
| Rate for Payer: HFN Commercial |
$3,737.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,047.25
|
| Rate for Payer: Multiplan Commercial |
$3,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,437.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,737.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,990.87
|
| Rate for Payer: Quartz Commercial |
$2,640.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,437.80
|
| Rate for Payer: The Alliance Commercial |
$16,252.00
|
| Rate for Payer: WEA Trust Commercial |
$2,234.65
|
| Rate for Payer: WPS Commercial |
$3,009.46
|
|
|
CLAMP ISOLATOR ABLATION SHORT OSL2
|
Facility
IP
|
$22,929.00
|
|
| Hospital Charge Code |
2964752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11,235.21 |
| Max. Negotiated Rate |
$21,094.68 |
| Rate for Payer: Aetna Commercial |
$20,636.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,152.37
|
| Rate for Payer: Cash Price |
$6,878.70
|
| Rate for Payer: Cigna Commercial |
$21,094.68
|
| Rate for Payer: Health EOS Commercial |
$20,406.81
|
| Rate for Payer: HFN Commercial |
$21,094.68
|
| Rate for Payer: Multiplan Commercial |
$18,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$13,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21,094.68
|
| Rate for Payer: Quartz Beloit One Network |
$11,235.21
|
| Rate for Payer: Quartz Commercial |
$13,757.40
|
| Rate for Payer: WEA Trust Commercial |
$12,610.95
|
| Rate for Payer: WPS Commercial |
$16,983.51
|
|
|
CLAMP ISOLATOR ABLATION SHORT OSL2
|
Facility
OP
|
$22,929.00
|
|
| Hospital Charge Code |
2964752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,420.12 |
| Max. Negotiated Rate |
$91,716.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,420.12
|
| Rate for Payer: Aetna Commercial |
$20,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,718.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,903.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,464.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,005.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,152.37
|
| Rate for Payer: Cash Price |
$6,878.70
|
| Rate for Payer: Cigna Commercial |
$21,094.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,831.07
|
| Rate for Payer: Health EOS Commercial |
$20,406.81
|
| Rate for Payer: HFN Commercial |
$21,094.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,196.75
|
| Rate for Payer: Multiplan Commercial |
$18,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$13,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21,094.68
|
| Rate for Payer: Quartz Beloit One Network |
$11,235.21
|
| Rate for Payer: Quartz Commercial |
$14,903.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13,757.40
|
| Rate for Payer: The Alliance Commercial |
$91,716.00
|
| Rate for Payer: WEA Trust Commercial |
$12,610.95
|
| Rate for Payer: WPS Commercial |
$16,983.51
|
|
|
CLAMP LARGE MULTI-PIN 6 POSITION 390.002
|
Facility
OP
|
$7,863.00
|
|
| Hospital Charge Code |
2969385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,201.64 |
| Max. Negotiated Rate |
$31,452.00 |
| Rate for Payer: Aetna Commercial |
$7,076.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,762.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,201.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,110.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,931.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,167.39
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,233.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,400.13
|
| Rate for Payer: Health EOS Commercial |
$6,998.07
|
| Rate for Payer: HFN Commercial |
$7,233.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,897.25
|
| Rate for Payer: Multiplan Commercial |
$6,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.87
|
| Rate for Payer: Quartz Commercial |
$5,110.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,717.80
|
| Rate for Payer: The Alliance Commercial |
$31,452.00
|
| Rate for Payer: WEA Trust Commercial |
$4,324.65
|
| Rate for Payer: WPS Commercial |
$5,824.12
|
|
|
CLAMP LARGE MULTI-PIN 6 POSITION 390.002
|
Facility
IP
|
$7,863.00
|
|
| Hospital Charge Code |
2969385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,852.87 |
| Max. Negotiated Rate |
$7,233.96 |
| Rate for Payer: Aetna Commercial |
$7,076.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,167.39
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,233.96
|
| Rate for Payer: Health EOS Commercial |
$6,998.07
|
| Rate for Payer: HFN Commercial |
$7,233.96
|
| Rate for Payer: Multiplan Commercial |
$6,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.87
|
| Rate for Payer: Quartz Commercial |
$4,717.80
|
| Rate for Payer: WEA Trust Commercial |
$4,324.65
|
| Rate for Payer: WPS Commercial |
$5,824.12
|
|
|
CLAMP LARGE OPEN ADJUSTABLE (MR SAFE) 390.008
|
Facility
OP
|
$5,933.00
|
|
| Hospital Charge Code |
2966165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,661.24 |
| Max. Negotiated Rate |
$23,732.00 |
| Rate for Payer: Aetna Commercial |
$5,339.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,102.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,661.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,856.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,966.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,847.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,144.49
|
| Rate for Payer: Cash Price |
$1,779.90
|
| Rate for Payer: Cigna Commercial |
$5,458.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,320.11
|
| Rate for Payer: Health EOS Commercial |
$5,280.37
|
| Rate for Payer: HFN Commercial |
$5,458.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,449.75
|
| Rate for Payer: Multiplan Commercial |
$4,746.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,559.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,458.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.17
|
| Rate for Payer: Quartz Commercial |
$3,856.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,559.80
|
| Rate for Payer: The Alliance Commercial |
$23,732.00
|
| Rate for Payer: WEA Trust Commercial |
$3,263.15
|
| Rate for Payer: WPS Commercial |
$4,394.57
|
|
|
CLAMP LARGE OPEN ADJUSTABLE (MR SAFE) 390.008
|
Facility
IP
|
$5,933.00
|
|
| Hospital Charge Code |
2966165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,907.17 |
| Max. Negotiated Rate |
$5,458.36 |
| Rate for Payer: Aetna Commercial |
$5,339.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,144.49
|
| Rate for Payer: Cash Price |
$1,779.90
|
| Rate for Payer: Cigna Commercial |
$5,458.36
|
| Rate for Payer: Health EOS Commercial |
$5,280.37
|
| Rate for Payer: HFN Commercial |
$5,458.36
|
| Rate for Payer: Multiplan Commercial |
$4,746.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,559.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,458.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.17
|
| Rate for Payer: Quartz Commercial |
$3,559.80
|
| Rate for Payer: WEA Trust Commercial |
$3,263.15
|
| Rate for Payer: WPS Commercial |
$4,394.57
|
|
|
CLAMP LG COMBINATION SNAP-ON (MR SAFE) 390.005
|
Facility
OP
|
$6,918.00
|
|
| Hospital Charge Code |
2966166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,937.04 |
| Max. Negotiated Rate |
$27,672.00 |
| Rate for Payer: Aetna Commercial |
$6,226.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,937.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,496.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,320.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,666.54
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$6,364.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,871.31
|
| Rate for Payer: Health EOS Commercial |
$6,157.02
|
| Rate for Payer: HFN Commercial |
$6,364.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,188.50
|
| Rate for Payer: Multiplan Commercial |
$5,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,364.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,389.82
|
| Rate for Payer: Quartz Commercial |
$4,496.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,150.80
|
| Rate for Payer: The Alliance Commercial |
$27,672.00
|
| Rate for Payer: WEA Trust Commercial |
$3,804.90
|
| Rate for Payer: WPS Commercial |
$5,124.16
|
|
|
CLAMP LG COMBINATION SNAP-ON (MR SAFE) 390.005
|
Facility
IP
|
$6,918.00
|
|
| Hospital Charge Code |
2966166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,389.82 |
| Max. Negotiated Rate |
$6,364.56 |
| Rate for Payer: Aetna Commercial |
$6,226.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,666.54
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$6,364.56
|
| Rate for Payer: Health EOS Commercial |
$6,157.02
|
| Rate for Payer: HFN Commercial |
$6,364.56
|
| Rate for Payer: Multiplan Commercial |
$5,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,364.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,389.82
|
| Rate for Payer: Quartz Commercial |
$4,150.80
|
| Rate for Payer: WEA Trust Commercial |
$3,804.90
|
| Rate for Payer: WPS Commercial |
$5,124.16
|
|
|
CLAMP MR SMALL EXTERNAL FIXATOR 395.597
|
Facility
IP
|
$5,168.00
|
|
| Hospital Charge Code |
4494322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,532.32 |
| Max. Negotiated Rate |
$4,754.56 |
| Rate for Payer: Aetna Commercial |
$4,651.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,739.04
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cigna Commercial |
$4,754.56
|
| Rate for Payer: Health EOS Commercial |
$4,599.52
|
| Rate for Payer: HFN Commercial |
$4,754.56
|
| Rate for Payer: Multiplan Commercial |
$4,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,754.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,532.32
|
| Rate for Payer: Quartz Commercial |
$3,100.80
|
| Rate for Payer: WEA Trust Commercial |
$2,842.40
|
| Rate for Payer: WPS Commercial |
$3,827.94
|
|
|
CLAMP MR SMALL EXTERNAL FIXATOR 395.597
|
Facility
OP
|
$5,168.00
|
|
| Hospital Charge Code |
4494322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,447.04 |
| Max. Negotiated Rate |
$20,672.00 |
| Rate for Payer: Aetna Commercial |
$4,651.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,444.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,447.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,359.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,584.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,480.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,739.04
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cigna Commercial |
$4,754.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,892.01
|
| Rate for Payer: Health EOS Commercial |
$4,599.52
|
| Rate for Payer: HFN Commercial |
$4,754.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,876.00
|
| Rate for Payer: Multiplan Commercial |
$4,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,754.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,532.32
|
| Rate for Payer: Quartz Commercial |
$3,359.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,100.80
|
| Rate for Payer: The Alliance Commercial |
$20,672.00
|
| Rate for Payer: WEA Trust Commercial |
$2,842.40
|
| Rate for Payer: WPS Commercial |
$3,827.94
|
|
|
CLAMP MULTI-PIN 4960-2-020
|
Facility
OP
|
$3,806.00
|
|
| Hospital Charge Code |
5349472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,065.68 |
| Max. Negotiated Rate |
$15,224.00 |
| Rate for Payer: Aetna Commercial |
$3,425.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,273.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,065.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,473.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,903.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,826.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,017.18
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,501.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,129.84
|
| Rate for Payer: Health EOS Commercial |
$3,387.34
|
| Rate for Payer: HFN Commercial |
$3,501.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,854.50
|
| Rate for Payer: Multiplan Commercial |
$3,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,283.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,501.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.94
|
| Rate for Payer: Quartz Commercial |
$2,473.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,283.60
|
| Rate for Payer: The Alliance Commercial |
$15,224.00
|
| Rate for Payer: WEA Trust Commercial |
$2,093.30
|
| Rate for Payer: WPS Commercial |
$2,819.10
|
|
|
CLAMP MULTI-PIN 4960-2-020
|
Facility
IP
|
$3,806.00
|
|
| Hospital Charge Code |
5349472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,864.94 |
| Max. Negotiated Rate |
$3,501.52 |
| Rate for Payer: Aetna Commercial |
$3,425.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,017.18
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,501.52
|
| Rate for Payer: Health EOS Commercial |
$3,387.34
|
| Rate for Payer: HFN Commercial |
$3,501.52
|
| Rate for Payer: Multiplan Commercial |
$3,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,283.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,501.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.94
|
| Rate for Payer: Quartz Commercial |
$2,283.60
|
| Rate for Payer: WEA Trust Commercial |
$2,093.30
|
| Rate for Payer: WPS Commercial |
$2,819.10
|
|
|
CLAMP OPEN 393.69
|
Facility
IP
|
$2,107.00
|
|
| Hospital Charge Code |
5811627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.43 |
| Max. Negotiated Rate |
$1,938.44 |
| Rate for Payer: Aetna Commercial |
$1,896.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.71
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$1,938.44
|
| Rate for Payer: Health EOS Commercial |
$1,875.23
|
| Rate for Payer: HFN Commercial |
$1,938.44
|
| Rate for Payer: Multiplan Commercial |
$1,685.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,938.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.43
|
| Rate for Payer: Quartz Commercial |
$1,264.20
|
| Rate for Payer: WEA Trust Commercial |
$1,158.85
|
| Rate for Payer: WPS Commercial |
$1,560.65
|
|
|
CLAMP OPEN 393.69
|
Facility
OP
|
$2,107.00
|
|
| Hospital Charge Code |
5811627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.96 |
| Max. Negotiated Rate |
$8,428.00 |
| Rate for Payer: Aetna Commercial |
$1,896.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.02
|
| Rate for Payer: Aetna Managed Medicare |
$589.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,369.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,011.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.71
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$1,938.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.08
|
| Rate for Payer: Health EOS Commercial |
$1,875.23
|
| Rate for Payer: HFN Commercial |
$1,938.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,580.25
|
| Rate for Payer: Multiplan Commercial |
$1,685.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,938.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.43
|
| Rate for Payer: Quartz Commercial |
$1,369.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,264.20
|
| Rate for Payer: The Alliance Commercial |
$8,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.85
|
| Rate for Payer: WPS Commercial |
$1,560.65
|
|
|
CLAMP TRANSFER SET W/TWIST MINI CAP 5C4482
|
Facility
IP
|
$1,158.00
|
|
| Hospital Charge Code |
2973417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.42 |
| Max. Negotiated Rate |
$1,065.36 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$694.80
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
CLAMP TRANSFER SET W/TWIST MINI CAP 5C4482
|
Facility
OP
|
$1,158.00
|
|
| Hospital Charge Code |
2973417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.24 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Aetna Managed Medicare |
$324.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$752.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$555.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.02
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$752.70
|
| Rate for Payer: Quartz Medicare Advantage |
$694.80
|
| Rate for Payer: The Alliance Commercial |
$4,632.00
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
CLAMP TRANSVERSE 393.66
|
Facility
IP
|
$3,727.00
|
|
| Hospital Charge Code |
5811626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,826.23 |
| Max. Negotiated Rate |
$3,428.84 |
| Rate for Payer: Aetna Commercial |
$3,354.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,975.31
|
| Rate for Payer: Cash Price |
$1,118.10
|
| Rate for Payer: Cigna Commercial |
$3,428.84
|
| Rate for Payer: Health EOS Commercial |
$3,317.03
|
| Rate for Payer: HFN Commercial |
$3,428.84
|
| Rate for Payer: Multiplan Commercial |
$2,981.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,236.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,428.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,826.23
|
| Rate for Payer: Quartz Commercial |
$2,236.20
|
| Rate for Payer: WEA Trust Commercial |
$2,049.85
|
| Rate for Payer: WPS Commercial |
$2,760.59
|
|
|
CLAMP TRANSVERSE 393.66
|
Facility
OP
|
$3,727.00
|
|
| Hospital Charge Code |
5811626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,043.56 |
| Max. Negotiated Rate |
$14,908.00 |
| Rate for Payer: Aetna Commercial |
$3,354.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,205.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,043.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,422.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,863.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,788.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,975.31
|
| Rate for Payer: Cash Price |
$1,118.10
|
| Rate for Payer: Cigna Commercial |
$3,428.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,085.63
|
| Rate for Payer: Health EOS Commercial |
$3,317.03
|
| Rate for Payer: HFN Commercial |
$3,428.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,795.25
|
| Rate for Payer: Multiplan Commercial |
$2,981.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,236.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,428.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,826.23
|
| Rate for Payer: Quartz Commercial |
$2,422.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,236.20
|
| Rate for Payer: The Alliance Commercial |
$14,908.00
|
| Rate for Payer: WEA Trust Commercial |
$2,049.85
|
| Rate for Payer: WPS Commercial |
$2,760.59
|
|
|
CLAMP UMBILICAL CORD
|
Facility
IP
|
$48.00
|
|
| Hospital Charge Code |
2963464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
