|
CLIP 16MM ASSURANCE 00711884
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
6204980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP 18MM ASSURANCE 00711885
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6204981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$320.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$743.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$743.60
|
| Rate for Payer: Quartz Medicare Advantage |
$686.40
|
| Rate for Payer: The Alliance Commercial |
$572.00
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP 18MM ASSURANCE 00711885
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
6204981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP APPLIER ENDO 10MM (MED/LRG) ER320
|
Facility
|
OP
|
$1,362.00
|
|
| Hospital Charge Code |
3591509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.61 |
| Max. Negotiated Rate |
$1,303.16 |
| Rate for Payer: Aetna Commercial |
$1,274.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,218.17
|
| Rate for Payer: Aetna Managed Medicare |
$396.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$920.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$708.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.73
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,303.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.68
|
| Rate for Payer: Health EOS Commercial |
$1,260.67
|
| Rate for Payer: HFN Commercial |
$1,303.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,062.36
|
| Rate for Payer: Multiplan Commercial |
$1,133.18
|
| Rate for Payer: NAPHCARE Commercial |
$849.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,303.16
|
| Rate for Payer: Quartz Beloit One Network |
$694.08
|
| Rate for Payer: Quartz Commercial |
$920.71
|
| Rate for Payer: Quartz Medicare Advantage |
$849.89
|
| Rate for Payer: The Alliance Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$779.06
|
| Rate for Payer: WPS Commercial |
$1,049.15
|
|
|
CLIP APPLIER ENDO 10MM (MED/LRG) ER320
|
Facility
|
IP
|
$1,362.00
|
|
| Hospital Charge Code |
3591509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$1,303.16 |
| Rate for Payer: Aetna Commercial |
$1,274.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,218.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.73
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,303.16
|
| Rate for Payer: Health EOS Commercial |
$1,260.67
|
| Rate for Payer: HFN Commercial |
$1,303.16
|
| Rate for Payer: Multiplan Commercial |
$1,133.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,303.16
|
| Rate for Payer: Quartz Beloit One Network |
$694.08
|
| Rate for Payer: Quartz Commercial |
$849.89
|
| Rate for Payer: WEA Trust Commercial |
$779.06
|
| Rate for Payer: WPS Commercial |
$1,049.15
|
|
|
CLIP DISPOSABLE GONIO IPRISM CLIP IPC01
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
5349364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
CLIP DISPOSABLE GONIO IPRISM CLIP IPC01
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
5349364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
CLIP HEM-O-LOK LARGE PURPLE 544240
|
Facility
|
IP
|
$968.00
|
|
| Hospital Charge Code |
4595666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.29 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$906.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.56
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$926.18
|
| Rate for Payer: Health EOS Commercial |
$895.98
|
| Rate for Payer: HFN Commercial |
$926.18
|
| Rate for Payer: Multiplan Commercial |
$805.38
|
| Rate for Payer: Preferred Network Access Commercial |
$926.18
|
| Rate for Payer: Quartz Beloit One Network |
$493.29
|
| Rate for Payer: Quartz Commercial |
$604.03
|
| Rate for Payer: WEA Trust Commercial |
$553.70
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
|
CLIP HEM-O-LOK LARGE PURPLE 544240
|
Facility
|
OP
|
$968.00
|
|
| Hospital Charge Code |
4595666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.88 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$906.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.78
|
| Rate for Payer: Aetna Managed Medicare |
$281.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$654.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$483.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.56
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$926.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.38
|
| Rate for Payer: Health EOS Commercial |
$895.98
|
| Rate for Payer: HFN Commercial |
$926.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$755.04
|
| Rate for Payer: Multiplan Commercial |
$805.38
|
| Rate for Payer: NAPHCARE Commercial |
$604.03
|
| Rate for Payer: Preferred Network Access Commercial |
$926.18
|
| Rate for Payer: Quartz Beloit One Network |
$493.29
|
| Rate for Payer: Quartz Commercial |
$654.37
|
| Rate for Payer: Quartz Medicare Advantage |
$604.03
|
| Rate for Payer: The Alliance Commercial |
$503.36
|
| Rate for Payer: WEA Trust Commercial |
$553.70
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
|
CLIP HEM-O-LOK MEDIUM/LARGE GREEN 544230
|
Facility
|
OP
|
$968.00
|
|
| Hospital Charge Code |
4595665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.88 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$906.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.78
|
| Rate for Payer: Aetna Managed Medicare |
$281.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$654.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$483.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.56
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$926.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.38
|
| Rate for Payer: Health EOS Commercial |
$895.98
|
| Rate for Payer: HFN Commercial |
$926.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$755.04
|
| Rate for Payer: Multiplan Commercial |
$805.38
|
| Rate for Payer: NAPHCARE Commercial |
$604.03
|
| Rate for Payer: Preferred Network Access Commercial |
$926.18
|
| Rate for Payer: Quartz Beloit One Network |
$493.29
|
| Rate for Payer: Quartz Commercial |
$654.37
|
| Rate for Payer: Quartz Medicare Advantage |
$604.03
|
| Rate for Payer: The Alliance Commercial |
$503.36
|
| Rate for Payer: WEA Trust Commercial |
$553.70
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
|
CLIP HEM-O-LOK MEDIUM/LARGE GREEN 544230
|
Facility
|
IP
|
$968.00
|
|
| Hospital Charge Code |
4595665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.29 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$906.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.56
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$926.18
|
| Rate for Payer: Health EOS Commercial |
$895.98
|
| Rate for Payer: HFN Commercial |
$926.18
|
| Rate for Payer: Multiplan Commercial |
$805.38
|
| Rate for Payer: Preferred Network Access Commercial |
$926.18
|
| Rate for Payer: Quartz Beloit One Network |
$493.29
|
| Rate for Payer: Quartz Commercial |
$604.03
|
| Rate for Payer: WEA Trust Commercial |
$553.70
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
|
CLIP II APPLIER ENDO MD/LG
|
Facility
|
OP
|
$1,743.00
|
|
| Hospital Charge Code |
2962904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.56 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Aetna Managed Medicare |
$507.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,178.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$870.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.43
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.54
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,178.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.63
|
| Rate for Payer: The Alliance Commercial |
$906.36
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
CLIP II APPLIER ENDO MD/LG
|
Facility
|
IP
|
$1,743.00
|
|
| Hospital Charge Code |
2962904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.23 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,087.63
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
CLIP INSTINCT COOK G18343
|
Facility
|
IP
|
$2,682.00
|
|
| Hospital Charge Code |
4520206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,366.75 |
| Max. Negotiated Rate |
$2,566.14 |
| Rate for Payer: Aetna Commercial |
$2,510.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,398.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.32
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$2,566.14
|
| Rate for Payer: Health EOS Commercial |
$2,482.46
|
| Rate for Payer: HFN Commercial |
$2,566.14
|
| Rate for Payer: Multiplan Commercial |
$2,231.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,366.75
|
| Rate for Payer: Quartz Commercial |
$1,673.57
|
| Rate for Payer: WEA Trust Commercial |
$1,534.10
|
| Rate for Payer: WPS Commercial |
$2,065.94
|
|
|
CLIP INSTINCT COOK G18343
|
Facility
|
OP
|
$2,682.00
|
|
| Hospital Charge Code |
4520206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.00 |
| Max. Negotiated Rate |
$2,566.14 |
| Rate for Payer: Aetna Commercial |
$2,510.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,398.78
|
| Rate for Payer: Aetna Managed Medicare |
$781.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,394.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,338.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.32
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$2,566.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,560.92
|
| Rate for Payer: Health EOS Commercial |
$2,482.46
|
| Rate for Payer: HFN Commercial |
$2,566.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,091.96
|
| Rate for Payer: Multiplan Commercial |
$2,231.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,673.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,366.75
|
| Rate for Payer: Quartz Commercial |
$1,813.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,673.57
|
| Rate for Payer: The Alliance Commercial |
$1,394.64
|
| Rate for Payer: WEA Trust Commercial |
$1,534.10
|
| Rate for Payer: WPS Commercial |
$2,065.94
|
|
|
CLIP PADLOCK COLON C913131
|
Facility
|
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5415938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$862.99
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
CLIP PADLOCK COLON C913131
|
Facility
|
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5415938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$934.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$719.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.91
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.74
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$862.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$934.91
|
| Rate for Payer: Quartz Medicare Advantage |
$862.99
|
| Rate for Payer: The Alliance Commercial |
$719.16
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
CLIP PADLOCK EGD C910001
|
Facility
|
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5415937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$934.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$719.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.91
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.74
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$862.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$934.91
|
| Rate for Payer: Quartz Medicare Advantage |
$862.99
|
| Rate for Payer: The Alliance Commercial |
$719.16
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
CLIP PADLOCK EGD C910001
|
Facility
|
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5415937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$862.99
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
Clipper Blades
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
3040366
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Clipper Blades
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3040366
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
CLIPPER NAIL DISPOSABLE
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2965773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
CLIPPER NAIL DISPOSABLE
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2965773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
CLIP RESOLUTION 360 M00521232
|
Facility
|
IP
|
$2,356.00
|
|
| Hospital Charge Code |
5414811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.62 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,470.14
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
CLIP RESOLUTION 360 M00521232
|
Facility
|
OP
|
$2,356.00
|
|
| Hospital Charge Code |
5414811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.07 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Aetna Managed Medicare |
$686.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,592.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,225.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,176.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.19
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,837.68
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,592.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,470.14
|
| Rate for Payer: The Alliance Commercial |
$1,225.12
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
