|
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
|
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 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 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
|
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 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 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
|
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
|
|
|
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 TRANSVERSE 393.66
|
Facility
|
OP
|
$3,727.00
|
|
| Hospital Charge Code |
5811626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,085.30 |
| Max. Negotiated Rate |
$3,565.99 |
| Rate for Payer: Aetna Commercial |
$3,488.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,333.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,085.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,519.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,938.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,860.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,054.32
|
| Rate for Payer: Cash Price |
$1,118.10
|
| Rate for Payer: Cigna Commercial |
$3,565.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,169.11
|
| Rate for Payer: Health EOS Commercial |
$3,449.71
|
| Rate for Payer: HFN Commercial |
$3,565.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,907.06
|
| Rate for Payer: Multiplan Commercial |
$3,100.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,325.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,565.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,899.28
|
| Rate for Payer: Quartz Commercial |
$2,519.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,325.65
|
| Rate for Payer: The Alliance Commercial |
$1,938.04
|
| Rate for Payer: WEA Trust Commercial |
$2,131.84
|
| Rate for Payer: WPS Commercial |
$2,870.91
|
|
|
CLAMP TRANSVERSE 393.66
|
Facility
|
IP
|
$3,727.00
|
|
| Hospital Charge Code |
5811626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,899.28 |
| Max. Negotiated Rate |
$3,565.99 |
| Rate for Payer: Aetna Commercial |
$3,488.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,333.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,054.32
|
| Rate for Payer: Cash Price |
$1,118.10
|
| Rate for Payer: Cigna Commercial |
$3,565.99
|
| Rate for Payer: Health EOS Commercial |
$3,449.71
|
| Rate for Payer: HFN Commercial |
$3,565.99
|
| Rate for Payer: Multiplan Commercial |
$3,100.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,565.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,899.28
|
| Rate for Payer: Quartz Commercial |
$2,325.65
|
| Rate for Payer: WEA Trust Commercial |
$2,131.84
|
| Rate for Payer: WPS Commercial |
$2,870.91
|
|
|
CLAMP UMBILICAL CORD
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2963464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
CLAMP UMBILICAL CORD
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2963464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
CLAMP UNIVERSAL 393.75
|
Facility
|
OP
|
$4,859.00
|
|
| Hospital Charge Code |
5811629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,414.94 |
| Max. Negotiated Rate |
$4,649.09 |
| Rate for Payer: Aetna Commercial |
$4,548.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,345.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,284.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,526.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,425.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.28
|
| Rate for Payer: Cash Price |
$1,457.70
|
| Rate for Payer: Cigna Commercial |
$4,649.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,827.94
|
| Rate for Payer: Health EOS Commercial |
$4,497.49
|
| Rate for Payer: HFN Commercial |
$4,649.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,790.02
|
| Rate for Payer: Multiplan Commercial |
$4,042.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,032.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,649.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,476.15
|
| Rate for Payer: Quartz Commercial |
$3,284.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,032.02
|
| Rate for Payer: The Alliance Commercial |
$2,526.68
|
| Rate for Payer: WEA Trust Commercial |
$2,779.35
|
| Rate for Payer: WPS Commercial |
$3,742.89
|
|
|
CLAMP UNIVERSAL 393.75
|
Facility
|
IP
|
$4,859.00
|
|
| Hospital Charge Code |
5811629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,476.15 |
| Max. Negotiated Rate |
$4,649.09 |
| Rate for Payer: Aetna Commercial |
$4,548.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,345.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.28
|
| Rate for Payer: Cash Price |
$1,457.70
|
| Rate for Payer: Cigna Commercial |
$4,649.09
|
| Rate for Payer: Health EOS Commercial |
$4,497.49
|
| Rate for Payer: HFN Commercial |
$4,649.09
|
| Rate for Payer: Multiplan Commercial |
$4,042.69
|
| Rate for Payer: Preferred Network Access Commercial |
$4,649.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,476.15
|
| Rate for Payer: Quartz Commercial |
$3,032.02
|
| Rate for Payer: WEA Trust Commercial |
$2,779.35
|
| Rate for Payer: WPS Commercial |
$3,742.89
|
|
|
Clapping
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989716
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Clapping
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989716
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Clarient, FISH Manual
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
5194629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.85 |
| Max. Negotiated Rate |
$532.94 |
| Rate for Payer: Aetna Commercial |
$521.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$532.94
|
| Rate for Payer: Health EOS Commercial |
$515.56
|
| Rate for Payer: HFN Commercial |
$532.94
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: Preferred Network Access Commercial |
$532.94
|
| Rate for Payer: Quartz Beloit One Network |
$283.85
|
| Rate for Payer: Quartz Commercial |
$347.57
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
