|
SUTURE LASSO FIBERSTICK LT AR-4068TLF
|
Facility
|
IP
|
$2,715.00
|
|
| Hospital Charge Code |
2964719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,330.35 |
| Max. Negotiated Rate |
$2,497.80 |
| Rate for Payer: Aetna Commercial |
$2,443.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.95
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,497.80
|
| Rate for Payer: Health EOS Commercial |
$2,416.35
|
| Rate for Payer: HFN Commercial |
$2,497.80
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,629.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.35
|
| Rate for Payer: Quartz Commercial |
$1,629.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.25
|
| Rate for Payer: WPS Commercial |
$2,011.00
|
|
|
SUTURE LASSO FIBERSTICK LT AR-4068TLF
|
Facility
|
OP
|
$2,715.00
|
|
| Hospital Charge Code |
2964719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.20 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Aetna Commercial |
$2,443.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.90
|
| Rate for Payer: Aetna Managed Medicare |
$760.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,764.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.95
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,497.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,519.31
|
| Rate for Payer: Health EOS Commercial |
$2,416.35
|
| Rate for Payer: HFN Commercial |
$2,497.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,036.25
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,629.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.35
|
| Rate for Payer: Quartz Commercial |
$1,764.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,629.00
|
| Rate for Payer: The Alliance Commercial |
$10,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.25
|
| Rate for Payer: WPS Commercial |
$2,011.00
|
|
|
SUTURE LASSO FIBERSTICK RT AR-4068TRF
|
Facility
|
OP
|
$2,715.00
|
|
| Hospital Charge Code |
2964720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.20 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Aetna Commercial |
$2,443.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.90
|
| Rate for Payer: Aetna Managed Medicare |
$760.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,764.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.95
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,497.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,519.31
|
| Rate for Payer: Health EOS Commercial |
$2,416.35
|
| Rate for Payer: HFN Commercial |
$2,497.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,036.25
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,629.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.35
|
| Rate for Payer: Quartz Commercial |
$1,764.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,629.00
|
| Rate for Payer: The Alliance Commercial |
$10,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.25
|
| Rate for Payer: WPS Commercial |
$2,011.00
|
|
|
SUTURE LASSO FIBERSTICK RT AR-4068TRF
|
Facility
|
IP
|
$2,715.00
|
|
| Hospital Charge Code |
2964720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,330.35 |
| Max. Negotiated Rate |
$2,497.80 |
| Rate for Payer: Aetna Commercial |
$2,443.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.95
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,497.80
|
| Rate for Payer: Health EOS Commercial |
$2,416.35
|
| Rate for Payer: HFN Commercial |
$2,497.80
|
| Rate for Payer: Multiplan Commercial |
$2,172.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,629.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.35
|
| Rate for Payer: Quartz Commercial |
$1,629.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.25
|
| Rate for Payer: WPS Commercial |
$2,011.00
|
|
|
SUTURE LASSO MICRO AR-8701
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
SUTURE LASSO MICRO AR-8701
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
SUTURE LASSO SD WIRE LOOP AR-4068-05SD
|
Facility
|
IP
|
$628.00
|
|
| Hospital Charge Code |
5106618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$577.76 |
| Rate for Payer: Aetna Commercial |
$565.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$540.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.84
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$577.76
|
| Rate for Payer: Health EOS Commercial |
$558.92
|
| Rate for Payer: HFN Commercial |
$577.76
|
| Rate for Payer: Multiplan Commercial |
$502.40
|
| Rate for Payer: NAPHCARE Commercial |
$376.80
|
| Rate for Payer: Preferred Network Access Commercial |
$577.76
|
| Rate for Payer: Quartz Beloit One Network |
$307.72
|
| Rate for Payer: Quartz Commercial |
$376.80
|
| Rate for Payer: WEA Trust Commercial |
$345.40
|
| Rate for Payer: WPS Commercial |
$465.16
|
|
|
SUTURE LASSO SD WIRE LOOP AR-4068-05SD
|
Facility
|
OP
|
$628.00
|
|
| Hospital Charge Code |
5106618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.84 |
| Max. Negotiated Rate |
$2,512.00 |
| Rate for Payer: Aetna Commercial |
$565.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$540.08
|
| Rate for Payer: Aetna Managed Medicare |
$175.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$408.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$314.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.84
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$577.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$351.43
|
| Rate for Payer: Health EOS Commercial |
$558.92
|
| Rate for Payer: HFN Commercial |
$577.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$471.00
|
| Rate for Payer: Multiplan Commercial |
$502.40
|
| Rate for Payer: NAPHCARE Commercial |
$376.80
|
| Rate for Payer: Preferred Network Access Commercial |
$577.76
|
| Rate for Payer: Quartz Beloit One Network |
$307.72
|
| Rate for Payer: Quartz Commercial |
$408.20
|
| Rate for Payer: Quartz Medicare Advantage |
$376.80
|
| Rate for Payer: The Alliance Commercial |
$2,512.00
|
| Rate for Payer: WEA Trust Commercial |
$345.40
|
| Rate for Payer: WPS Commercial |
$465.16
|
|
|
SUTURE LT 45DEG SHUTTLE IDEAL 251003
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.13 |
| Max. Negotiated Rate |
$2,886.04 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$1,882.20
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
SUTURE LT 45DEG SHUTTLE IDEAL 251003
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.36 |
| Max. Negotiated Rate |
$12,548.00 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Aetna Managed Medicare |
$878.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,039.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.47
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.75
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$2,039.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,882.20
|
| Rate for Payer: The Alliance Commercial |
$12,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
SUTURE MENISCAL REPAIR 8536
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
2964885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$627.44 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$409.20
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
SUTURE MENISCAL REPAIR 8536
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
2964885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.96 |
| Max. Negotiated Rate |
$2,728.00 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Aetna Managed Medicare |
$190.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.65
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.50
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$443.30
|
| Rate for Payer: Quartz Medicare Advantage |
$409.20
|
| Rate for Payer: The Alliance Commercial |
$2,728.00
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
SUTURE NOVAFIL,BLUE 6-0
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE NOVAFIL,BLUE 6-0
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE NYLON 697G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE NYLON 697G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Suture Of Recent Wound, Eyelid
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
1190831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$323.22 |
| Max. Negotiated Rate |
$1,562.75 |
| Rate for Payer: Aetna Commercial |
$1,562.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.70
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna Commercial |
$1,562.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$323.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$987.00
|
| Rate for Payer: Health EOS Commercial |
$1,496.95
|
| Rate for Payer: HFN Commercial |
$1,562.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$797.43
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,562.75
|
| Rate for Payer: Quartz Beloit One Network |
$723.80
|
| Rate for Payer: Quartz Commercial |
$937.65
|
| Rate for Payer: The Alliance Commercial |
$822.50
|
| Rate for Payer: United Healthcare Medicaid |
$323.22
|
| Rate for Payer: WEA Trust Commercial |
$904.75
|
| Rate for Payer: WPS Commercial |
$1,218.45
|
|
|
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY OR RUPTURE; SINGLE PERFORATION
|
Facility
|
OP
|
$11,874.87
|
|
|
Service Code
|
CPT 44602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
|
|
SUTURE PASSER BLUE MEDIUM 9893
|
Facility
|
OP
|
$1,124.00
|
|
| Hospital Charge Code |
2964887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.72 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna Commercial |
$1,011.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.64
|
| Rate for Payer: Aetna Managed Medicare |
$314.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$730.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$539.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.72
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,034.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$628.99
|
| Rate for Payer: Health EOS Commercial |
$1,000.36
|
| Rate for Payer: HFN Commercial |
$1,034.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$899.20
|
| Rate for Payer: NAPHCARE Commercial |
$674.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.08
|
| Rate for Payer: Quartz Beloit One Network |
$550.76
|
| Rate for Payer: Quartz Commercial |
$730.60
|
| Rate for Payer: Quartz Medicare Advantage |
$674.40
|
| Rate for Payer: The Alliance Commercial |
$4,496.00
|
| Rate for Payer: WEA Trust Commercial |
$618.20
|
| Rate for Payer: WPS Commercial |
$832.55
|
|
|
SUTURE PASSER BLUE MEDIUM 9893
|
Facility
|
IP
|
$1,124.00
|
|
| Hospital Charge Code |
2964887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.76 |
| Max. Negotiated Rate |
$1,034.08 |
| Rate for Payer: Aetna Commercial |
$1,011.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.72
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,034.08
|
| Rate for Payer: Health EOS Commercial |
$1,000.36
|
| Rate for Payer: HFN Commercial |
$1,034.08
|
| Rate for Payer: Multiplan Commercial |
$899.20
|
| Rate for Payer: NAPHCARE Commercial |
$674.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.08
|
| Rate for Payer: Quartz Beloit One Network |
$550.76
|
| Rate for Payer: Quartz Commercial |
$674.40
|
| Rate for Payer: WEA Trust Commercial |
$618.20
|
| Rate for Payer: WPS Commercial |
$832.55
|
|
|
SUTURE PASSER GREEN LARGE 9894
|
Facility
|
OP
|
$1,082.00
|
|
| Hospital Charge Code |
2964886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.96 |
| Max. Negotiated Rate |
$4,328.00 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Aetna Managed Medicare |
$302.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$703.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$541.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$519.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.46
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$995.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.49
|
| Rate for Payer: Health EOS Commercial |
$962.98
|
| Rate for Payer: HFN Commercial |
$995.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$811.50
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: NAPHCARE Commercial |
$649.20
|
| Rate for Payer: Preferred Network Access Commercial |
$995.44
|
| Rate for Payer: Quartz Beloit One Network |
$530.18
|
| Rate for Payer: Quartz Commercial |
$703.30
|
| Rate for Payer: Quartz Medicare Advantage |
$649.20
|
| Rate for Payer: The Alliance Commercial |
$4,328.00
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
SUTURE PASSER GREEN LARGE 9894
|
Facility
|
IP
|
$1,082.00
|
|
| Hospital Charge Code |
2964886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.18 |
| Max. Negotiated Rate |
$995.44 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.46
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$995.44
|
| Rate for Payer: Health EOS Commercial |
$962.98
|
| Rate for Payer: HFN Commercial |
$995.44
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: NAPHCARE Commercial |
$649.20
|
| Rate for Payer: Preferred Network Access Commercial |
$995.44
|
| Rate for Payer: Quartz Beloit One Network |
$530.18
|
| Rate for Payer: Quartz Commercial |
$649.20
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
SUTURE PASSER SWIFTSTITCH HIP AR-4068HL
|
Facility
|
OP
|
$3,649.00
|
|
| Hospital Charge Code |
5459478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.72 |
| Max. Negotiated Rate |
$14,596.00 |
| Rate for Payer: Aetna Commercial |
$3,284.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,138.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,021.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,371.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,824.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,751.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,933.97
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,357.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,041.98
|
| Rate for Payer: Health EOS Commercial |
$3,247.61
|
| Rate for Payer: HFN Commercial |
$3,357.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,736.75
|
| Rate for Payer: Multiplan Commercial |
$2,919.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,189.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,357.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.01
|
| Rate for Payer: Quartz Commercial |
$2,371.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,189.40
|
| Rate for Payer: The Alliance Commercial |
$14,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,006.95
|
| Rate for Payer: WPS Commercial |
$2,702.81
|
|
|
SUTURE PASSER SWIFTSTITCH HIP AR-4068HL
|
Facility
|
IP
|
$3,649.00
|
|
| Hospital Charge Code |
5459478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,788.01 |
| Max. Negotiated Rate |
$3,357.08 |
| Rate for Payer: Aetna Commercial |
$3,284.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,138.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,933.97
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,357.08
|
| Rate for Payer: Health EOS Commercial |
$3,247.61
|
| Rate for Payer: HFN Commercial |
$3,357.08
|
| Rate for Payer: Multiplan Commercial |
$2,919.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,189.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,357.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.01
|
| Rate for Payer: Quartz Commercial |
$2,189.40
|
| Rate for Payer: WEA Trust Commercial |
$2,006.95
|
| Rate for Payer: WPS Commercial |
$2,702.81
|
|
|
SUTURE PASSER YELLOW SMALL 9892
|
Facility
|
IP
|
$1,124.00
|
|
| Hospital Charge Code |
2965531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.76 |
| Max. Negotiated Rate |
$1,034.08 |
| Rate for Payer: Aetna Commercial |
$1,011.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.72
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,034.08
|
| Rate for Payer: Health EOS Commercial |
$1,000.36
|
| Rate for Payer: HFN Commercial |
$1,034.08
|
| Rate for Payer: Multiplan Commercial |
$899.20
|
| Rate for Payer: NAPHCARE Commercial |
$674.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.08
|
| Rate for Payer: Quartz Beloit One Network |
$550.76
|
| Rate for Payer: Quartz Commercial |
$674.40
|
| Rate for Payer: WEA Trust Commercial |
$618.20
|
| Rate for Payer: WPS Commercial |
$832.55
|
|
