|
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 |
$4,838.14 |
| 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 39 AR-9502F-39CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| 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 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 |
$2,764.65 |
| 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 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 |
$4,838.14 |
| 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 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 |
$2,764.65 |
| 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 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 |
$4,838.14 |
| 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 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 |
$2,764.65 |
| 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 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 |
$4,838.14 |
| 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 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 |
$2,764.65 |
| 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 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 |
$4,838.14 |
| 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 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 |
$2,764.65 |
| 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 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 |
$4,838.14 |
| 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 CV4 GORTEX 3200A
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2975075
|
|
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 CV4 GORTEX 3200A
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2975075
|
|
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 DERMALON 4-0 BLUE 18
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2969040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE DERMALON 4-0 BLUE 18
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2969040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE ETHILCON 6-0 697G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974648
|
|
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 ETHILCON 6-0 697G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974648
|
|
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 FIBERLOOP WITH CURVED NEEDLE AR-7234C
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
2964718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.00
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$520.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
SUTURE FIBERLOOP WITH CURVED NEEDLE AR-7234C
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
2964718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
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 |
$1,219.84 |
| Max. Negotiated Rate |
$4,008.04 |
| Rate for Payer: Aetna Commercial |
$3,920.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,746.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,831.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,178.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,091.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,308.98
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$4,008.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,438.00
|
| Rate for Payer: Health EOS Commercial |
$3,877.34
|
| Rate for Payer: HFN Commercial |
$4,008.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,267.42
|
| Rate for Payer: Multiplan Commercial |
$3,485.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,613.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.71
|
| Rate for Payer: Quartz Commercial |
$2,831.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,613.94
|
| Rate for Payer: The Alliance Commercial |
$2,178.28
|
| Rate for Payer: WEA Trust Commercial |
$2,396.11
|
| Rate for Payer: WPS Commercial |
$3,226.79
|
|
|
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 |
$2,134.71 |
| Max. Negotiated Rate |
$4,008.04 |
| Rate for Payer: Aetna Commercial |
$3,920.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,746.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,308.98
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$4,008.04
|
| Rate for Payer: Health EOS Commercial |
$3,877.34
|
| Rate for Payer: HFN Commercial |
$4,008.04
|
| Rate for Payer: Multiplan Commercial |
$3,485.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.71
|
| Rate for Payer: Quartz Commercial |
$2,613.94
|
| Rate for Payer: WEA Trust Commercial |
$2,396.11
|
| Rate for Payer: WPS Commercial |
$3,226.79
|
|
|
SUTURE FIBERSTICK #2 AR-7209
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2964670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SUTURE FIBERSTICK #2 AR-7209
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2964670
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SUTURE FIBERTAPE AR-7237-7
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
5190728
|
|
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
|
|
