|
CLIP 13MM ASSURANCE 00711883
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6217003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$4,400.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$946.00
|
| Rate for Payer: Aetna Managed Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$715.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$550.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.56
|
| Rate for Payer: Health EOS Commercial |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$715.00
|
| Rate for Payer: Quartz Medicare Advantage |
$660.00
|
| Rate for Payer: The Alliance Commercial |
$4,400.00
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
CLIP 16MM ASSURANCE 00711884
|
Facility
IP
|
$1,100.00
|
|
| Hospital Charge Code |
6204980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$1,012.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Health EOS Commercial |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$660.00
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
CLIP 16MM ASSURANCE 00711884
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6204980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$4,400.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$946.00
|
| Rate for Payer: Aetna Managed Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$715.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$550.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.56
|
| Rate for Payer: Health EOS Commercial |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$715.00
|
| Rate for Payer: Quartz Medicare Advantage |
$660.00
|
| Rate for Payer: The Alliance Commercial |
$4,400.00
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
CLIP 18MM ASSURANCE 00711885
|
Facility
IP
|
$1,100.00
|
|
| Hospital Charge Code |
6204981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$1,012.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Health EOS Commercial |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$660.00
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
CLIP 18MM ASSURANCE 00711885
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6204981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$4,400.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$946.00
|
| Rate for Payer: Aetna Managed Medicare |
$308.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$715.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$550.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$528.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.56
|
| Rate for Payer: Health EOS Commercial |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$715.00
|
| Rate for Payer: Quartz Medicare Advantage |
$660.00
|
| Rate for Payer: The Alliance Commercial |
$4,400.00
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
CLIP APPLIER ENDO 10MM (MED/LRG) ER320
|
Facility
OP
|
$1,362.00
|
|
| Hospital Charge Code |
3591509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.36 |
| Max. Negotiated Rate |
$5,448.00 |
| Rate for Payer: Aetna Commercial |
$1,225.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,171.32
|
| Rate for Payer: Aetna Managed Medicare |
$381.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$885.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$681.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.86
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,253.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$762.18
|
| Rate for Payer: Health EOS Commercial |
$1,212.18
|
| Rate for Payer: HFN Commercial |
$1,253.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.50
|
| Rate for Payer: Multiplan Commercial |
$1,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,253.04
|
| Rate for Payer: Quartz Beloit One Network |
$667.38
|
| Rate for Payer: Quartz Commercial |
$885.30
|
| Rate for Payer: Quartz Medicare Advantage |
$817.20
|
| Rate for Payer: The Alliance Commercial |
$5,448.00
|
| Rate for Payer: WEA Trust Commercial |
$749.10
|
| Rate for Payer: WPS Commercial |
$1,008.83
|
|
|
CLIP APPLIER ENDO 10MM (MED/LRG) ER320
|
Facility
IP
|
$1,362.00
|
|
| Hospital Charge Code |
3591509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.38 |
| Max. Negotiated Rate |
$1,253.04 |
| Rate for Payer: Aetna Commercial |
$1,225.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.86
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,253.04
|
| Rate for Payer: Health EOS Commercial |
$1,212.18
|
| Rate for Payer: HFN Commercial |
$1,253.04
|
| Rate for Payer: Multiplan Commercial |
$1,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,253.04
|
| Rate for Payer: Quartz Beloit One Network |
$667.38
|
| Rate for Payer: Quartz Commercial |
$817.20
|
| Rate for Payer: WEA Trust Commercial |
$749.10
|
| Rate for Payer: WPS Commercial |
$1,008.83
|
|
|
CLIP DISPOSABLE GONIO IPRISM CLIP IPC01
|
Facility
OP
|
$915.00
|
|
| Hospital Charge Code |
5349364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
CLIP DISPOSABLE GONIO IPRISM CLIP IPC01
|
Facility
IP
|
$915.00
|
|
| Hospital Charge Code |
5349364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
CLIP HEM-O-LOK LARGE PURPLE 544240
|
Facility
IP
|
$968.00
|
|
| Hospital Charge Code |
4595666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$890.56 |
| Rate for Payer: Aetna Commercial |
$871.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.04
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$890.56
|
| Rate for Payer: Health EOS Commercial |
$861.52
|
| Rate for Payer: HFN Commercial |
$890.56
|
| Rate for Payer: Multiplan Commercial |
$774.40
|
| Rate for Payer: NAPHCARE Commercial |
$580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$890.56
|
| Rate for Payer: Quartz Beloit One Network |
$474.32
|
| Rate for Payer: Quartz Commercial |
$580.80
|
| Rate for Payer: WEA Trust Commercial |
$532.40
|
| Rate for Payer: WPS Commercial |
$717.00
|
|
|
CLIP HEM-O-LOK LARGE PURPLE 544240
|
Facility
OP
|
$968.00
|
|
| Hospital Charge Code |
4595666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$3,872.00 |
| Rate for Payer: Aetna Commercial |
$871.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.48
|
| Rate for Payer: Aetna Managed Medicare |
$271.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$629.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.04
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$890.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$541.69
|
| Rate for Payer: Health EOS Commercial |
$861.52
|
| Rate for Payer: HFN Commercial |
$890.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.00
|
| Rate for Payer: Multiplan Commercial |
$774.40
|
| Rate for Payer: NAPHCARE Commercial |
$580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$890.56
|
| Rate for Payer: Quartz Beloit One Network |
$474.32
|
| Rate for Payer: Quartz Commercial |
$629.20
|
| Rate for Payer: Quartz Medicare Advantage |
$580.80
|
| Rate for Payer: The Alliance Commercial |
$3,872.00
|
| Rate for Payer: WEA Trust Commercial |
$532.40
|
| Rate for Payer: WPS Commercial |
$717.00
|
|
|
CLIP HEM-O-LOK MEDIUM/LARGE GREEN 544230
|
Facility
IP
|
$968.00
|
|
| Hospital Charge Code |
4595665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$890.56 |
| Rate for Payer: Aetna Commercial |
$871.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.04
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$890.56
|
| Rate for Payer: Health EOS Commercial |
$861.52
|
| Rate for Payer: HFN Commercial |
$890.56
|
| Rate for Payer: Multiplan Commercial |
$774.40
|
| Rate for Payer: NAPHCARE Commercial |
$580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$890.56
|
| Rate for Payer: Quartz Beloit One Network |
$474.32
|
| Rate for Payer: Quartz Commercial |
$580.80
|
| Rate for Payer: WEA Trust Commercial |
$532.40
|
| Rate for Payer: WPS Commercial |
$717.00
|
|
|
CLIP HEM-O-LOK MEDIUM/LARGE GREEN 544230
|
Facility
OP
|
$968.00
|
|
| Hospital Charge Code |
4595665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$3,872.00 |
| Rate for Payer: Aetna Commercial |
$871.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.48
|
| Rate for Payer: Aetna Managed Medicare |
$271.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$629.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.04
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$890.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$541.69
|
| Rate for Payer: Health EOS Commercial |
$861.52
|
| Rate for Payer: HFN Commercial |
$890.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.00
|
| Rate for Payer: Multiplan Commercial |
$774.40
|
| Rate for Payer: NAPHCARE Commercial |
$580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$890.56
|
| Rate for Payer: Quartz Beloit One Network |
$474.32
|
| Rate for Payer: Quartz Commercial |
$629.20
|
| Rate for Payer: Quartz Medicare Advantage |
$580.80
|
| Rate for Payer: The Alliance Commercial |
$3,872.00
|
| Rate for Payer: WEA Trust Commercial |
$532.40
|
| Rate for Payer: WPS Commercial |
$717.00
|
|
|
CLIP II APPLIER ENDO MD/LG
|
Facility
OP
|
$1,743.00
|
|
| Hospital Charge Code |
2962904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.04 |
| Max. Negotiated Rate |
$6,972.00 |
| Rate for Payer: Aetna Commercial |
$1,568.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,498.98
|
| Rate for Payer: Aetna Managed Medicare |
$488.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,132.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$871.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$836.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.79
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,603.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$975.38
|
| Rate for Payer: Health EOS Commercial |
$1,551.27
|
| Rate for Payer: HFN Commercial |
$1,603.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,307.25
|
| Rate for Payer: Multiplan Commercial |
$1,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.56
|
| Rate for Payer: Quartz Beloit One Network |
$854.07
|
| Rate for Payer: Quartz Commercial |
$1,132.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,045.80
|
| Rate for Payer: The Alliance Commercial |
$6,972.00
|
| Rate for Payer: WEA Trust Commercial |
$958.65
|
| Rate for Payer: WPS Commercial |
$1,291.04
|
|
|
CLIP II APPLIER ENDO MD/LG
|
Facility
IP
|
$1,743.00
|
|
| Hospital Charge Code |
2962904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$854.07 |
| Max. Negotiated Rate |
$1,603.56 |
| Rate for Payer: Aetna Commercial |
$1,568.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$923.79
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,603.56
|
| Rate for Payer: Health EOS Commercial |
$1,551.27
|
| Rate for Payer: HFN Commercial |
$1,603.56
|
| Rate for Payer: Multiplan Commercial |
$1,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.56
|
| Rate for Payer: Quartz Beloit One Network |
$854.07
|
| Rate for Payer: Quartz Commercial |
$1,045.80
|
| Rate for Payer: WEA Trust Commercial |
$958.65
|
| Rate for Payer: WPS Commercial |
$1,291.04
|
|
|
CLIP PADLOCK COLON C913131
|
Facility
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5415938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.24 |
| Max. Negotiated Rate |
$5,532.00 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.38
|
| Rate for Payer: Aetna Managed Medicare |
$387.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.93
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.25
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$898.95
|
| Rate for Payer: Quartz Medicare Advantage |
$829.80
|
| Rate for Payer: The Alliance Commercial |
$5,532.00
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
CLIP PADLOCK COLON C913131
|
Facility
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5415938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.67 |
| Max. Negotiated Rate |
$1,272.36 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$829.80
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
CLIP PADLOCK EGD C910001
|
Facility
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5415937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.24 |
| Max. Negotiated Rate |
$5,532.00 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.38
|
| Rate for Payer: Aetna Managed Medicare |
$387.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.93
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.25
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$898.95
|
| Rate for Payer: Quartz Medicare Advantage |
$829.80
|
| Rate for Payer: The Alliance Commercial |
$5,532.00
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
CLIP PADLOCK EGD C910001
|
Facility
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5415937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.67 |
| Max. Negotiated Rate |
$1,272.36 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$829.80
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
Clipper Blades
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
3040366
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Clipper Blades
|
Facility
IP
|
$7.00
|
|
| Hospital Charge Code |
3040366
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
CLIPPER NAIL DISPOSABLE
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
2965773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
CLIPPER NAIL DISPOSABLE
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
2965773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
CLIP RESOLUTION 360 M00521232
|
Facility
IP
|
$2,356.00
|
|
| Hospital Charge Code |
5414811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.44 |
| Max. Negotiated Rate |
$2,167.52 |
| Rate for Payer: Aetna Commercial |
$2,120.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,248.68
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,167.52
|
| Rate for Payer: Health EOS Commercial |
$2,096.84
|
| Rate for Payer: HFN Commercial |
$2,167.52
|
| Rate for Payer: Multiplan Commercial |
$1,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,167.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.44
|
| Rate for Payer: Quartz Commercial |
$1,413.60
|
| Rate for Payer: WEA Trust Commercial |
$1,295.80
|
| Rate for Payer: WPS Commercial |
$1,745.09
|
|
|
CLIP RESOLUTION 360 M00521232
|
Facility
OP
|
$2,356.00
|
|
| Hospital Charge Code |
5414811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.68 |
| Max. Negotiated Rate |
$9,424.00 |
| Rate for Payer: Aetna Commercial |
$2,120.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,026.16
|
| Rate for Payer: Aetna Managed Medicare |
$659.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,531.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,130.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,248.68
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,167.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,318.42
|
| Rate for Payer: Health EOS Commercial |
$2,096.84
|
| Rate for Payer: HFN Commercial |
$2,167.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,767.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,167.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.44
|
| Rate for Payer: Quartz Commercial |
$1,531.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,413.60
|
| Rate for Payer: The Alliance Commercial |
$9,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,295.80
|
| Rate for Payer: WPS Commercial |
$1,745.09
|
|
