|
CLAMP ADJUSTABLE WIRE PIN
|
Facility
|
OP
|
$8,681.00
|
|
| Hospital Charge Code |
2966163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,527.91 |
| Max. Negotiated Rate |
$8,305.98 |
| Rate for Payer: Aetna Commercial |
$8,125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,764.29
|
| Rate for Payer: Aetna Managed Medicare |
$2,527.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,868.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,514.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,333.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,784.97
|
| Rate for Payer: Cash Price |
$2,604.30
|
| Rate for Payer: Cigna Commercial |
$8,305.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,052.34
|
| Rate for Payer: Health EOS Commercial |
$8,035.13
|
| Rate for Payer: HFN Commercial |
$8,305.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,771.18
|
| Rate for Payer: Multiplan Commercial |
$7,222.59
|
| Rate for Payer: NAPHCARE Commercial |
$5,416.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,305.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,423.84
|
| Rate for Payer: Quartz Commercial |
$5,868.36
|
| Rate for Payer: Quartz Medicare Advantage |
$5,416.94
|
| Rate for Payer: The Alliance Commercial |
$4,514.12
|
| Rate for Payer: WEA Trust Commercial |
$4,965.53
|
| Rate for Payer: WPS Commercial |
$6,686.97
|
|
|
CLAMP COVER RED 061011PBX
|
Facility
|
IP
|
$62.00
|
|
| Hospital Charge Code |
2965506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
CLAMP COVER RED 061011PBX
|
Facility
|
OP
|
$62.00
|
|
| Hospital Charge Code |
2965506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$32.24
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
CLAMP DISPOSABLE PLASTIC
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
2972252
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
CLAMP DISPOSABLE PLASTIC
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
2972252
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
CLAMP HOFFMANN 3 10 HOLE 4921-2-060
|
Facility
|
OP
|
$4,575.00
|
|
| Hospital Charge Code |
5685709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,332.24 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,092.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,283.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,662.65
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,568.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$3,092.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,854.80
|
| Rate for Payer: The Alliance Commercial |
$2,379.00
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
CLAMP HOFFMANN 3 10 HOLE 4921-2-060
|
Facility
|
IP
|
$4,575.00
|
|
| Hospital Charge Code |
5685709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,331.42 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$2,854.80
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
CLAMP HOLDING 1.25MM 395.125
|
Facility
|
IP
|
$4,063.00
|
|
| Hospital Charge Code |
5771655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,070.50 |
| Max. Negotiated Rate |
$3,887.48 |
| Rate for Payer: Aetna Commercial |
$3,802.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,633.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,239.53
|
| Rate for Payer: Cash Price |
$1,218.90
|
| Rate for Payer: Cigna Commercial |
$3,887.48
|
| Rate for Payer: Health EOS Commercial |
$3,760.71
|
| Rate for Payer: HFN Commercial |
$3,887.48
|
| Rate for Payer: Multiplan Commercial |
$3,380.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,887.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,070.50
|
| Rate for Payer: Quartz Commercial |
$2,535.31
|
| Rate for Payer: WEA Trust Commercial |
$2,324.04
|
| Rate for Payer: WPS Commercial |
$3,129.73
|
|
|
CLAMP HOLDING 1.25MM 395.125
|
Facility
|
OP
|
$4,063.00
|
|
| Hospital Charge Code |
5771655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,183.15 |
| Max. Negotiated Rate |
$3,887.48 |
| Rate for Payer: Aetna Commercial |
$3,802.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,633.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,183.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,746.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,112.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,028.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,239.53
|
| Rate for Payer: Cash Price |
$1,218.90
|
| Rate for Payer: Cigna Commercial |
$3,887.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,364.67
|
| Rate for Payer: Health EOS Commercial |
$3,760.71
|
| Rate for Payer: HFN Commercial |
$3,887.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,169.14
|
| Rate for Payer: Multiplan Commercial |
$3,380.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,535.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,887.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,070.50
|
| Rate for Payer: Quartz Commercial |
$2,746.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,535.31
|
| Rate for Payer: The Alliance Commercial |
$2,112.76
|
| Rate for Payer: WEA Trust Commercial |
$2,324.04
|
| Rate for Payer: WPS Commercial |
$3,129.73
|
|
|
CLAMP ISOLATOR ABLATION SHORT OSL2
|
Facility
|
IP
|
$22,929.00
|
|
| Hospital Charge Code |
2964752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11,684.62 |
| Max. Negotiated Rate |
$21,938.47 |
| Rate for Payer: Aetna Commercial |
$21,461.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,507.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,638.46
|
| Rate for Payer: Cash Price |
$6,878.70
|
| Rate for Payer: Cigna Commercial |
$21,938.47
|
| Rate for Payer: Health EOS Commercial |
$21,223.08
|
| Rate for Payer: HFN Commercial |
$21,938.47
|
| Rate for Payer: Multiplan Commercial |
$19,076.93
|
| Rate for Payer: Preferred Network Access Commercial |
$21,938.47
|
| Rate for Payer: Quartz Beloit One Network |
$11,684.62
|
| Rate for Payer: Quartz Commercial |
$14,307.70
|
| Rate for Payer: WEA Trust Commercial |
$13,115.39
|
| Rate for Payer: WPS Commercial |
$17,662.21
|
|
|
CLAMP ISOLATOR ABLATION SHORT OSL2
|
Facility
|
OP
|
$22,929.00
|
|
| Hospital Charge Code |
2964752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,676.92 |
| Max. Negotiated Rate |
$21,938.47 |
| Rate for Payer: Aetna Commercial |
$21,461.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,507.70
|
| Rate for Payer: Aetna Managed Medicare |
$6,676.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,500.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,923.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,446.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,638.46
|
| Rate for Payer: Cash Price |
$6,878.70
|
| Rate for Payer: Cigna Commercial |
$21,938.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,344.68
|
| Rate for Payer: Health EOS Commercial |
$21,223.08
|
| Rate for Payer: HFN Commercial |
$21,938.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,884.62
|
| Rate for Payer: Multiplan Commercial |
$19,076.93
|
| Rate for Payer: NAPHCARE Commercial |
$14,307.70
|
| Rate for Payer: Preferred Network Access Commercial |
$21,938.47
|
| Rate for Payer: Quartz Beloit One Network |
$11,684.62
|
| Rate for Payer: Quartz Commercial |
$15,500.00
|
| Rate for Payer: Quartz Medicare Advantage |
$14,307.70
|
| Rate for Payer: The Alliance Commercial |
$11,923.08
|
| Rate for Payer: WEA Trust Commercial |
$13,115.39
|
| Rate for Payer: WPS Commercial |
$17,662.21
|
|
|
CLAMP LARGE MULTI-PIN 6 POSITION 390.002
|
Facility
|
IP
|
$7,863.00
|
|
| Hospital Charge Code |
2969385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,006.98 |
| Max. Negotiated Rate |
$7,523.32 |
| Rate for Payer: Aetna Commercial |
$7,359.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,032.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,334.09
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,523.32
|
| Rate for Payer: Health EOS Commercial |
$7,277.99
|
| Rate for Payer: HFN Commercial |
$7,523.32
|
| Rate for Payer: Multiplan Commercial |
$6,542.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,523.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,006.98
|
| Rate for Payer: Quartz Commercial |
$4,906.51
|
| Rate for Payer: WEA Trust Commercial |
$4,497.64
|
| Rate for Payer: WPS Commercial |
$6,056.87
|
|
|
CLAMP LARGE MULTI-PIN 6 POSITION 390.002
|
Facility
|
OP
|
$7,863.00
|
|
| Hospital Charge Code |
2969385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,289.71 |
| Max. Negotiated Rate |
$7,523.32 |
| Rate for Payer: Aetna Commercial |
$7,359.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,032.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,289.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,315.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,088.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,925.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,334.09
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,523.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,576.27
|
| Rate for Payer: Health EOS Commercial |
$7,277.99
|
| Rate for Payer: HFN Commercial |
$7,523.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,133.14
|
| Rate for Payer: Multiplan Commercial |
$6,542.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,906.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,523.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,006.98
|
| Rate for Payer: Quartz Commercial |
$5,315.39
|
| Rate for Payer: Quartz Medicare Advantage |
$4,906.51
|
| Rate for Payer: The Alliance Commercial |
$4,088.76
|
| Rate for Payer: WEA Trust Commercial |
$4,497.64
|
| Rate for Payer: WPS Commercial |
$6,056.87
|
|
|
CLAMP LARGE OPEN ADJUSTABLE (MR SAFE) 390.008
|
Facility
|
IP
|
$5,933.00
|
|
| Hospital Charge Code |
2966165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,023.46 |
| Max. Negotiated Rate |
$5,676.69 |
| Rate for Payer: Aetna Commercial |
$5,553.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,306.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,270.27
|
| Rate for Payer: Cash Price |
$1,779.90
|
| Rate for Payer: Cigna Commercial |
$5,676.69
|
| Rate for Payer: Health EOS Commercial |
$5,491.58
|
| Rate for Payer: HFN Commercial |
$5,676.69
|
| Rate for Payer: Multiplan Commercial |
$4,936.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,676.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,023.46
|
| Rate for Payer: Quartz Commercial |
$3,702.19
|
| Rate for Payer: WEA Trust Commercial |
$3,393.68
|
| Rate for Payer: WPS Commercial |
$4,570.19
|
|
|
CLAMP LARGE OPEN ADJUSTABLE (MR SAFE) 390.008
|
Facility
|
OP
|
$5,933.00
|
|
| Hospital Charge Code |
2966165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,727.69 |
| Max. Negotiated Rate |
$5,676.69 |
| Rate for Payer: Aetna Commercial |
$5,553.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,306.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,727.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,010.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,085.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,961.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,270.27
|
| Rate for Payer: Cash Price |
$1,779.90
|
| Rate for Payer: Cigna Commercial |
$5,676.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,453.01
|
| Rate for Payer: Health EOS Commercial |
$5,491.58
|
| Rate for Payer: HFN Commercial |
$5,676.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,627.74
|
| Rate for Payer: Multiplan Commercial |
$4,936.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,702.19
|
| Rate for Payer: Preferred Network Access Commercial |
$5,676.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,023.46
|
| Rate for Payer: Quartz Commercial |
$4,010.71
|
| Rate for Payer: Quartz Medicare Advantage |
$3,702.19
|
| Rate for Payer: The Alliance Commercial |
$3,085.16
|
| Rate for Payer: WEA Trust Commercial |
$3,393.68
|
| Rate for Payer: WPS Commercial |
$4,570.19
|
|
|
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 |
$2,014.52 |
| Max. Negotiated Rate |
$6,619.14 |
| Rate for Payer: Aetna Commercial |
$6,475.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,187.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,014.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,676.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,597.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,453.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,813.20
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$6,619.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,026.28
|
| Rate for Payer: Health EOS Commercial |
$6,403.30
|
| Rate for Payer: HFN Commercial |
$6,619.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,396.04
|
| Rate for Payer: Multiplan Commercial |
$5,755.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,316.83
|
| Rate for Payer: Preferred Network Access Commercial |
$6,619.14
|
| Rate for Payer: Quartz Beloit One Network |
$3,525.41
|
| Rate for Payer: Quartz Commercial |
$4,676.57
|
| Rate for Payer: Quartz Medicare Advantage |
$4,316.83
|
| Rate for Payer: The Alliance Commercial |
$3,597.36
|
| Rate for Payer: WEA Trust Commercial |
$3,957.10
|
| Rate for Payer: WPS Commercial |
$5,328.94
|
|
|
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 |
$3,525.41 |
| Max. Negotiated Rate |
$6,619.14 |
| Rate for Payer: Aetna Commercial |
$6,475.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,187.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,813.20
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$6,619.14
|
| Rate for Payer: Health EOS Commercial |
$6,403.30
|
| Rate for Payer: HFN Commercial |
$6,619.14
|
| Rate for Payer: Multiplan Commercial |
$5,755.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,619.14
|
| Rate for Payer: Quartz Beloit One Network |
$3,525.41
|
| Rate for Payer: Quartz Commercial |
$4,316.83
|
| Rate for Payer: WEA Trust Commercial |
$3,957.10
|
| Rate for Payer: WPS Commercial |
$5,328.94
|
|
|
CLAMP MR SMALL EXTERNAL FIXATOR 395.597
|
Facility
|
IP
|
$5,168.00
|
|
| Hospital Charge Code |
4494322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,633.61 |
| Max. Negotiated Rate |
$4,944.74 |
| Rate for Payer: Aetna Commercial |
$4,837.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,622.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,848.60
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cigna Commercial |
$4,944.74
|
| Rate for Payer: Health EOS Commercial |
$4,783.50
|
| Rate for Payer: HFN Commercial |
$4,944.74
|
| Rate for Payer: Multiplan Commercial |
$4,299.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,944.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,633.61
|
| Rate for Payer: Quartz Commercial |
$3,224.83
|
| Rate for Payer: WEA Trust Commercial |
$2,956.10
|
| Rate for Payer: WPS Commercial |
$3,980.91
|
|
|
CLAMP MR SMALL EXTERNAL FIXATOR 395.597
|
Facility
|
OP
|
$5,168.00
|
|
| Hospital Charge Code |
4494322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,504.92 |
| Max. Negotiated Rate |
$4,944.74 |
| Rate for Payer: Aetna Commercial |
$4,837.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,622.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,504.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,493.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,687.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,579.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,848.60
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cigna Commercial |
$4,944.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,007.78
|
| Rate for Payer: Health EOS Commercial |
$4,783.50
|
| Rate for Payer: HFN Commercial |
$4,944.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,031.04
|
| Rate for Payer: Multiplan Commercial |
$4,299.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,224.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,944.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,633.61
|
| Rate for Payer: Quartz Commercial |
$3,493.57
|
| Rate for Payer: Quartz Medicare Advantage |
$3,224.83
|
| Rate for Payer: The Alliance Commercial |
$2,687.36
|
| Rate for Payer: WEA Trust Commercial |
$2,956.10
|
| Rate for Payer: WPS Commercial |
$3,980.91
|
|
|
CLAMP MULTI-PIN 4960-2-020
|
Facility
|
OP
|
$3,806.00
|
|
| Hospital Charge Code |
5349472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,108.31 |
| Max. Negotiated Rate |
$3,641.58 |
| Rate for Payer: Aetna Commercial |
$3,562.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,404.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,572.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,979.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,899.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,097.87
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,641.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,215.09
|
| Rate for Payer: Health EOS Commercial |
$3,522.83
|
| Rate for Payer: HFN Commercial |
$3,641.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,968.68
|
| Rate for Payer: Multiplan Commercial |
$3,166.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,641.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,939.54
|
| Rate for Payer: Quartz Commercial |
$2,572.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,374.94
|
| Rate for Payer: The Alliance Commercial |
$1,979.12
|
| Rate for Payer: WEA Trust Commercial |
$2,177.03
|
| Rate for Payer: WPS Commercial |
$2,931.76
|
|
|
CLAMP MULTI-PIN 4960-2-020
|
Facility
|
IP
|
$3,806.00
|
|
| Hospital Charge Code |
5349472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,939.54 |
| Max. Negotiated Rate |
$3,641.58 |
| Rate for Payer: Aetna Commercial |
$3,562.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,404.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,097.87
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,641.58
|
| Rate for Payer: Health EOS Commercial |
$3,522.83
|
| Rate for Payer: HFN Commercial |
$3,641.58
|
| Rate for Payer: Multiplan Commercial |
$3,166.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,641.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,939.54
|
| Rate for Payer: Quartz Commercial |
$2,374.94
|
| Rate for Payer: WEA Trust Commercial |
$2,177.03
|
| Rate for Payer: WPS Commercial |
$2,931.76
|
|
|
CLAMP OPEN 393.69
|
Facility
|
OP
|
$2,107.00
|
|
| Hospital Charge Code |
5811627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$613.56 |
| Max. Negotiated Rate |
$2,015.98 |
| Rate for Payer: Aetna Commercial |
$1,972.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,884.50
|
| Rate for Payer: Aetna Managed Medicare |
$613.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.38
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$2,015.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.27
|
| Rate for Payer: Health EOS Commercial |
$1,950.24
|
| Rate for Payer: HFN Commercial |
$2,015.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,643.46
|
| Rate for Payer: Multiplan Commercial |
$1,753.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.73
|
| Rate for Payer: Quartz Commercial |
$1,424.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,314.77
|
| Rate for Payer: The Alliance Commercial |
$1,095.64
|
| Rate for Payer: WEA Trust Commercial |
$1,205.20
|
| Rate for Payer: WPS Commercial |
$1,623.02
|
|
|
CLAMP OPEN 393.69
|
Facility
|
IP
|
$2,107.00
|
|
| Hospital Charge Code |
5811627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,073.73 |
| Max. Negotiated Rate |
$2,015.98 |
| Rate for Payer: Aetna Commercial |
$1,972.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,884.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.38
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$2,015.98
|
| Rate for Payer: Health EOS Commercial |
$1,950.24
|
| Rate for Payer: HFN Commercial |
$2,015.98
|
| Rate for Payer: Multiplan Commercial |
$1,753.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.73
|
| Rate for Payer: Quartz Commercial |
$1,314.77
|
| Rate for Payer: WEA Trust Commercial |
$1,205.20
|
| Rate for Payer: WPS Commercial |
$1,623.02
|
|
|
CLAMP TRANSFER SET W/TWIST MINI CAP 5C4482
|
Facility
|
IP
|
$1,158.00
|
|
| Hospital Charge Code |
2973417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.12 |
| Max. Negotiated Rate |
$1,107.97 |
| Rate for Payer: Aetna Commercial |
$1,083.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.29
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,107.97
|
| Rate for Payer: Health EOS Commercial |
$1,071.84
|
| Rate for Payer: HFN Commercial |
$1,107.97
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.97
|
| Rate for Payer: Quartz Beloit One Network |
$590.12
|
| Rate for Payer: Quartz Commercial |
$722.59
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$892.01
|
|
|
CLAMP TRANSFER SET W/TWIST MINI CAP 5C4482
|
Facility
|
OP
|
$1,158.00
|
|
| Hospital Charge Code |
2973417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.21 |
| Max. Negotiated Rate |
$1,107.97 |
| Rate for Payer: Aetna Commercial |
$1,083.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Aetna Managed Medicare |
$337.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$782.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.29
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,107.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$673.96
|
| Rate for Payer: Health EOS Commercial |
$1,071.84
|
| Rate for Payer: HFN Commercial |
$1,107.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.24
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: NAPHCARE Commercial |
$722.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.97
|
| Rate for Payer: Quartz Beloit One Network |
$590.12
|
| Rate for Payer: Quartz Commercial |
$782.81
|
| Rate for Payer: Quartz Medicare Advantage |
$722.59
|
| Rate for Payer: The Alliance Commercial |
$602.16
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$892.01
|
|
