|
SUTURE CLOSURE DEVICE 3-0 V-LOC 2 METRIC NON-ABSORBABLE C-20 NEEDLE 6 IN VLOCN0604
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
5599597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC 90 PGA-PCL OS-2/P12 REVERSE CUT 12 IN UNDYED VL0CM0024
|
Facility
|
OP
|
$724.00
|
|
| Hospital Charge Code |
6214970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.83 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$210.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$376.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.37
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$564.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$489.42
|
| Rate for Payer: Quartz Medicare Advantage |
$451.78
|
| Rate for Payer: The Alliance Commercial |
$376.48
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC 90 PGA-PCL OS-2/P12 REVERSE CUT 12 IN UNDYED VL0CM0024
|
Facility
|
IP
|
$724.00
|
|
| Hospital Charge Code |
6214970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.95 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$451.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 6 IN VLOCL0804
|
Facility
|
OP
|
$544.00
|
|
| Hospital Charge Code |
5895668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.41 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Aetna Commercial |
$509.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.55
|
| Rate for Payer: Aetna Managed Medicare |
$158.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.85
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$520.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.61
|
| Rate for Payer: Health EOS Commercial |
$503.53
|
| Rate for Payer: HFN Commercial |
$520.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.32
|
| Rate for Payer: Multiplan Commercial |
$452.61
|
| Rate for Payer: NAPHCARE Commercial |
$339.46
|
| Rate for Payer: Preferred Network Access Commercial |
$520.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.22
|
| Rate for Payer: Quartz Commercial |
$367.74
|
| Rate for Payer: Quartz Medicare Advantage |
$339.46
|
| Rate for Payer: The Alliance Commercial |
$282.88
|
| Rate for Payer: WEA Trust Commercial |
$311.17
|
| Rate for Payer: WPS Commercial |
$419.04
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 6 IN VLOCL0804
|
Facility
|
IP
|
$544.00
|
|
| Hospital Charge Code |
5895668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.22 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Aetna Commercial |
$509.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.85
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$520.50
|
| Rate for Payer: Health EOS Commercial |
$503.53
|
| Rate for Payer: HFN Commercial |
$520.50
|
| Rate for Payer: Multiplan Commercial |
$452.61
|
| Rate for Payer: Preferred Network Access Commercial |
$520.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.22
|
| Rate for Payer: Quartz Commercial |
$339.46
|
| Rate for Payer: WEA Trust Commercial |
$311.17
|
| Rate for Payer: WPS Commercial |
$419.04
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 9 IN VLOCL0844
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
5917694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.28 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Aetna Managed Medicare |
$189.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$439.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.30
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: NAPHCARE Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$439.40
|
| Rate for Payer: Quartz Medicare Advantage |
$405.60
|
| Rate for Payer: The Alliance Commercial |
$338.00
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.69
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 9 IN VLOCL0844
|
Facility
|
IP
|
$650.00
|
|
| Hospital Charge Code |
5917694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.24 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.69
|
|
|
SUTURE CLOSURE DEVICE 4-0 V-LOC 90 UNDYED P-12 NEEDLE 12 IN VLOCM0013
|
Facility
|
IP
|
$531.00
|
|
| Hospital Charge Code |
5977642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$331.34
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
SUTURE CLOSURE DEVICE 4-0 V-LOC 90 UNDYED P-12 NEEDLE 12 IN VLOCM0013
|
Facility
|
OP
|
$531.00
|
|
| Hospital Charge Code |
5977642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.63 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$154.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.04
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.18
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$331.34
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$358.96
|
| Rate for Payer: Quartz Medicare Advantage |
$331.34
|
| Rate for Payer: The Alliance Commercial |
$276.12
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
SUTURE COTTONY II DACRON KC-25 89-5037W
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2965542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE COTTONY II DACRON KC-25 89-5037W
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE CTD VICRYL 5-0 J493G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CTD VICRYL 5-0 J493G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33LCPC
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,301.02 |
| Max. Negotiated Rate |
$8,075.39 |
| Rate for Payer: Aetna Commercial |
$7,899.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,548.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.13
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$8,075.39
|
| Rate for Payer: Health EOS Commercial |
$7,812.06
|
| Rate for Payer: HFN Commercial |
$8,075.39
|
| Rate for Payer: Multiplan Commercial |
$7,022.08
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.02
|
| Rate for Payer: Quartz Commercial |
$5,266.56
|
| Rate for Payer: WEA Trust Commercial |
$4,827.68
|
| Rate for Payer: WPS Commercial |
$6,501.33
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33LCPC
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,457.73 |
| Max. Negotiated Rate |
$8,075.39 |
| Rate for Payer: Aetna Commercial |
$7,899.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,548.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,457.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,705.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,388.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,213.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.13
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$8,075.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,912.08
|
| Rate for Payer: Health EOS Commercial |
$7,812.06
|
| Rate for Payer: HFN Commercial |
$8,075.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,583.20
|
| Rate for Payer: Multiplan Commercial |
$7,022.08
|
| Rate for Payer: NAPHCARE Commercial |
$5,266.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.02
|
| Rate for Payer: Quartz Commercial |
$5,705.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,266.56
|
| Rate for Payer: The Alliance Commercial |
$4,388.80
|
| Rate for Payer: WEA Trust Commercial |
$4,827.68
|
| Rate for Payer: WPS Commercial |
$6,501.33
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33RCPC
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,301.02 |
| Max. Negotiated Rate |
$8,075.39 |
| Rate for Payer: Aetna Commercial |
$7,899.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,548.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.13
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$8,075.39
|
| Rate for Payer: Health EOS Commercial |
$7,812.06
|
| Rate for Payer: HFN Commercial |
$8,075.39
|
| Rate for Payer: Multiplan Commercial |
$7,022.08
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.02
|
| Rate for Payer: Quartz Commercial |
$5,266.56
|
| Rate for Payer: WEA Trust Commercial |
$4,827.68
|
| Rate for Payer: WPS Commercial |
$6,501.33
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33RCPC
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,457.73 |
| Max. Negotiated Rate |
$8,075.39 |
| Rate for Payer: Aetna Commercial |
$7,899.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,548.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,457.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,705.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,388.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,213.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.13
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$8,075.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,912.08
|
| Rate for Payer: Health EOS Commercial |
$7,812.06
|
| Rate for Payer: HFN Commercial |
$8,075.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,583.20
|
| Rate for Payer: Multiplan Commercial |
$7,022.08
|
| Rate for Payer: NAPHCARE Commercial |
$5,266.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.02
|
| Rate for Payer: Quartz Commercial |
$5,705.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,266.56
|
| Rate for Payer: The Alliance Commercial |
$4,388.80
|
| Rate for Payer: WEA Trust Commercial |
$4,827.68
|
| Rate for Payer: WPS Commercial |
$6,501.33
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 AR-9502F-33CPC
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,457.73 |
| Max. Negotiated Rate |
$8,075.39 |
| Rate for Payer: Aetna Commercial |
$7,899.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,548.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,457.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,705.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,388.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,213.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.13
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$8,075.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,912.08
|
| Rate for Payer: Health EOS Commercial |
$7,812.06
|
| Rate for Payer: HFN Commercial |
$8,075.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,583.20
|
| Rate for Payer: Multiplan Commercial |
$7,022.08
|
| Rate for Payer: NAPHCARE Commercial |
$5,266.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.02
|
| Rate for Payer: Quartz Commercial |
$5,705.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,266.56
|
| Rate for Payer: The Alliance Commercial |
$4,388.80
|
| Rate for Payer: WEA Trust Commercial |
$4,827.68
|
| Rate for Payer: WPS Commercial |
$6,501.33
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 AR-9502F-33CPC
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,301.02 |
| Max. Negotiated Rate |
$8,075.39 |
| Rate for Payer: Aetna Commercial |
$7,899.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,548.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,652.13
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$8,075.39
|
| Rate for Payer: Health EOS Commercial |
$7,812.06
|
| Rate for Payer: HFN Commercial |
$8,075.39
|
| Rate for Payer: Multiplan Commercial |
$7,022.08
|
| Rate for Payer: Preferred Network Access Commercial |
$8,075.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,301.02
|
| Rate for Payer: Quartz Commercial |
$5,266.56
|
| Rate for Payer: WEA Trust Commercial |
$4,827.68
|
| Rate for Payer: WPS Commercial |
$6,501.33
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
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 |
$4,652.14 |
| Max. Negotiated Rate |
$8,734.63 |
| Rate for Payer: Aetna Commercial |
$8,544.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.90
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Cigna Commercial |
$8,734.63
|
| Rate for Payer: Health EOS Commercial |
$8,449.80
|
| Rate for Payer: HFN Commercial |
$8,734.63
|
| Rate for Payer: Multiplan Commercial |
$7,595.33
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.63
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.14
|
| Rate for Payer: Quartz Commercial |
$5,696.50
|
| Rate for Payer: WEA Trust Commercial |
$5,221.79
|
| Rate for Payer: WPS Commercial |
$7,032.07
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 +2 LT AR-9502F-39LCPC
|
Facility
|
OP
|
$9,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.36 |
| Max. Negotiated Rate |
$8,734.63 |
| Rate for Payer: Aetna Commercial |
$8,544.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.90
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Cigna Commercial |
$8,734.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,313.08
|
| Rate for Payer: Health EOS Commercial |
$8,449.80
|
| Rate for Payer: HFN Commercial |
$8,734.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.62
|
| Rate for Payer: Multiplan Commercial |
$7,595.33
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.63
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.14
|
| Rate for Payer: Quartz Commercial |
$6,171.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.50
|
| Rate for Payer: The Alliance Commercial |
$4,747.08
|
| Rate for Payer: WEA Trust Commercial |
$5,221.79
|
| Rate for Payer: WPS Commercial |
$7,032.07
|
|
