|
SUTURE CUP UNIVERSAL REVERSE 39 +2 LT AR-9502F-39LCPC
|
Facility
IP
|
$9,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,473.21 |
| Max. Negotiated Rate |
$8,398.68 |
| Rate for Payer: Aetna Commercial |
$8,216.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.37
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Cigna Commercial |
$8,398.68
|
| Rate for Payer: Health EOS Commercial |
$8,124.81
|
| Rate for Payer: HFN Commercial |
$8,398.68
|
| Rate for Payer: Multiplan Commercial |
$7,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,477.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.21
|
| Rate for Payer: Quartz Commercial |
$5,477.40
|
| Rate for Payer: WEA Trust Commercial |
$5,020.95
|
| Rate for Payer: WPS Commercial |
$6,761.85
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 AR-9502F-39CPC
|
Facility
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 AR-9502F-39CPC
|
Facility
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 LT AR-9502F-42LCPC
|
Facility
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 LT AR-9502F-42LCPC
|
Facility
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 RT AR-9502F-42RCPC
|
Facility
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5349059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 RT AR-9502F-42RCPC
|
Facility
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5349059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 NEUTRAL AR-9502F-42CPC
|
Facility
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 NEUTRAL AR-9502F-42CPC
|
Facility
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERS 39 +2 RT AR-9502F-39RCPC
|
Facility
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERS 39 +2 RT AR-9502F-39RCPC
|
Facility
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERSE 36 NUETRAL AR-9502F-36CPC
|
Facility
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERSE 36 NUETRAL AR-9502F-36CPC
|
Facility
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CV4 GORTEX 3200A
|
Facility
IP
|
$111.00
|
|
| Hospital Charge Code |
2975075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| 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 CV4 GORTEX 3200A
|
Facility
OP
|
$111.00
|
|
| Hospital Charge Code |
2975075
|
|
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 DERMALON 4-0 BLUE 18
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
2969040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
SUTURE DERMALON 4-0 BLUE 18
|
Facility
IP
|
$72.00
|
|
| Hospital Charge Code |
2969040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
SUTURE ETHILCON 6-0 697G
|
Facility
IP
|
$111.00
|
|
| Hospital Charge Code |
2974648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| 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 ETHILCON 6-0 697G
|
Facility
OP
|
$111.00
|
|
| Hospital Charge Code |
2974648
|
|
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 FIBERLOOP WITH CURVED NEEDLE AR-7234C
|
Facility
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2964718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
SUTURE FIBERLOOP WITH CURVED NEEDLE AR-7234C
|
Facility
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2964718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Quartz Commercial |
$650.00
|
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Managed Medicare |
$280.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.60
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$750.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Medicare Advantage |
$600.00
|
| Rate for Payer: The Alliance Commercial |
$4,000.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
SUTURE FIBERSNARE #2 FIBERWIRE #2 WITH CLOSED LOOP 26 IN AR-7209SN
|
Facility
OP
|
$4,189.00
|
|
| Hospital Charge Code |
5520872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,172.92 |
| Max. Negotiated Rate |
$16,756.00 |
| Rate for Payer: Aetna Commercial |
$3,770.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,602.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,172.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,722.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,094.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,010.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,220.17
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$3,853.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,344.16
|
| Rate for Payer: Health EOS Commercial |
$3,728.21
|
| Rate for Payer: HFN Commercial |
$3,853.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,141.75
|
| Rate for Payer: Multiplan Commercial |
$3,351.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,513.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,853.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,052.61
|
| Rate for Payer: Quartz Commercial |
$2,722.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,513.40
|
| Rate for Payer: The Alliance Commercial |
$16,756.00
|
| Rate for Payer: WEA Trust Commercial |
$2,303.95
|
| Rate for Payer: WPS Commercial |
$3,102.79
|
|
|
SUTURE FIBERSNARE #2 FIBERWIRE #2 WITH CLOSED LOOP 26 IN AR-7209SN
|
Facility
IP
|
$4,189.00
|
|
| Hospital Charge Code |
5520872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,052.61 |
| Max. Negotiated Rate |
$3,853.88 |
| Rate for Payer: Aetna Commercial |
$3,770.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,220.17
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$3,853.88
|
| Rate for Payer: Health EOS Commercial |
$3,728.21
|
| Rate for Payer: HFN Commercial |
$3,853.88
|
| Rate for Payer: Multiplan Commercial |
$3,351.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,513.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,853.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,052.61
|
| Rate for Payer: Quartz Commercial |
$2,513.40
|
| Rate for Payer: WEA Trust Commercial |
$2,303.95
|
| Rate for Payer: WPS Commercial |
$3,102.79
|
|
|
SUTURE FIBERSTICK #2 AR-7209
|
Facility
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2964670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SUTURE FIBERSTICK #2 AR-7209
|
Facility
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2964670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
