|
SUTURE FIBERTAPE AR-7237-7
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
5190728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
SUTURE FIBERWIRE #5 AR-7211
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2964662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
SUTURE FIBERWIRE #5 AR-7211
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2964662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
SUTURE GUIDE GABBY DEKGFS10
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
4518705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$865.81 |
| Max. Negotiated Rate |
$1,625.60 |
| Rate for Payer: Aetna Commercial |
$1,590.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,519.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$936.49
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,625.60
|
| Rate for Payer: Health EOS Commercial |
$1,572.59
|
| Rate for Payer: HFN Commercial |
$1,625.60
|
| Rate for Payer: Multiplan Commercial |
$1,413.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.60
|
| Rate for Payer: Quartz Beloit One Network |
$865.81
|
| Rate for Payer: Quartz Commercial |
$1,060.18
|
| Rate for Payer: WEA Trust Commercial |
$971.83
|
| Rate for Payer: WPS Commercial |
$1,308.74
|
|
|
SUTURE GUIDE GABBY DEKGFS10
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
4518705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.75 |
| Max. Negotiated Rate |
$1,625.60 |
| Rate for Payer: Aetna Commercial |
$1,590.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,519.59
|
| Rate for Payer: Aetna Managed Medicare |
$494.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,148.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$883.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$848.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$936.49
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,625.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.82
|
| Rate for Payer: Health EOS Commercial |
$1,572.59
|
| Rate for Payer: HFN Commercial |
$1,625.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,325.22
|
| Rate for Payer: Multiplan Commercial |
$1,413.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,060.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.60
|
| Rate for Payer: Quartz Beloit One Network |
$865.81
|
| Rate for Payer: Quartz Commercial |
$1,148.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,060.18
|
| Rate for Payer: The Alliance Commercial |
$883.48
|
| Rate for Payer: WEA Trust Commercial |
$971.83
|
| Rate for Payer: WPS Commercial |
$1,308.74
|
|
|
SUTURE KIT UNIVERS APEX DISP AR-7298
|
Facility
|
IP
|
$3,783.00
|
|
| Hospital Charge Code |
6179095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,927.82 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,360.59
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
SUTURE KIT UNIVERS APEX DISP AR-7298
|
Facility
|
OP
|
$3,783.00
|
|
| Hospital Charge Code |
6179095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,101.61 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,201.71
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,950.74
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,360.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,557.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,360.59
|
| Rate for Payer: The Alliance Commercial |
$1,967.16
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
SUTURE LASSO 25 DEGREE 25TL AR-4068-25TL
|
Facility
|
IP
|
$2,217.00
|
|
| Hospital Charge Code |
2964702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,129.78 |
| Max. Negotiated Rate |
$2,121.23 |
| Rate for Payer: Aetna Commercial |
$2,075.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,222.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,121.23
|
| Rate for Payer: Health EOS Commercial |
$2,052.06
|
| Rate for Payer: HFN Commercial |
$2,121.23
|
| Rate for Payer: Multiplan Commercial |
$1,844.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.78
|
| Rate for Payer: Quartz Commercial |
$1,383.41
|
| Rate for Payer: WEA Trust Commercial |
$1,268.12
|
| Rate for Payer: WPS Commercial |
$1,707.76
|
|
|
SUTURE LASSO 25 DEGREE 25TL AR-4068-25TL
|
Facility
|
OP
|
$2,217.00
|
|
| Hospital Charge Code |
2964702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$645.59 |
| Max. Negotiated Rate |
$2,121.23 |
| Rate for Payer: Aetna Commercial |
$2,075.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.88
|
| Rate for Payer: Aetna Managed Medicare |
$645.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,222.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,121.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,290.29
|
| Rate for Payer: Health EOS Commercial |
$2,052.06
|
| Rate for Payer: HFN Commercial |
$2,121.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,729.26
|
| Rate for Payer: Multiplan Commercial |
$1,844.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,383.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.78
|
| Rate for Payer: Quartz Commercial |
$1,498.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,383.41
|
| Rate for Payer: The Alliance Commercial |
$1,152.84
|
| Rate for Payer: WEA Trust Commercial |
$1,268.12
|
| Rate for Payer: WPS Commercial |
$1,707.76
|
|
|
SUTURE LASSO 25 DEGREE TIGHT RT CURVE AR-4068-25TR
|
Facility
|
OP
|
$2,217.00
|
|
| Hospital Charge Code |
2964701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$645.59 |
| Max. Negotiated Rate |
$2,121.23 |
| Rate for Payer: Aetna Commercial |
$2,075.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.88
|
| Rate for Payer: Aetna Managed Medicare |
$645.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,222.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,121.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,290.29
|
| Rate for Payer: Health EOS Commercial |
$2,052.06
|
| Rate for Payer: HFN Commercial |
$2,121.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,729.26
|
| Rate for Payer: Multiplan Commercial |
$1,844.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,383.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.78
|
| Rate for Payer: Quartz Commercial |
$1,498.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,383.41
|
| Rate for Payer: The Alliance Commercial |
$1,152.84
|
| Rate for Payer: WEA Trust Commercial |
$1,268.12
|
| Rate for Payer: WPS Commercial |
$1,707.76
|
|
|
SUTURE LASSO 25 DEGREE TIGHT RT CURVE AR-4068-25TR
|
Facility
|
IP
|
$2,217.00
|
|
| Hospital Charge Code |
2964701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,129.78 |
| Max. Negotiated Rate |
$2,121.23 |
| Rate for Payer: Aetna Commercial |
$2,075.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,222.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,121.23
|
| Rate for Payer: Health EOS Commercial |
$2,052.06
|
| Rate for Payer: HFN Commercial |
$2,121.23
|
| Rate for Payer: Multiplan Commercial |
$1,844.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.78
|
| Rate for Payer: Quartz Commercial |
$1,383.41
|
| Rate for Payer: WEA Trust Commercial |
$1,268.12
|
| Rate for Payer: WPS Commercial |
$1,707.76
|
|
|
SUTURE LASSO CRESCENT AR-4068C
|
Facility
|
OP
|
$2,135.00
|
|
| Hospital Charge Code |
2964703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.71 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Aetna Managed Medicare |
$621.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.57
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.30
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,443.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.24
|
| Rate for Payer: The Alliance Commercial |
$1,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
SUTURE LASSO CRESCENT AR-4068C
|
Facility
|
IP
|
$2,135.00
|
|
| Hospital Charge Code |
2964703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.00 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
SUTURE LASSO FIBERSTICK LT AR-4068TLF
|
Facility
|
IP
|
$2,715.00
|
|
| Hospital Charge Code |
2964719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.56 |
| Max. Negotiated Rate |
$2,597.71 |
| Rate for Payer: Aetna Commercial |
$2,541.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,428.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.51
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,597.71
|
| Rate for Payer: Health EOS Commercial |
$2,513.00
|
| Rate for Payer: HFN Commercial |
$2,597.71
|
| Rate for Payer: Multiplan Commercial |
$2,258.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.56
|
| Rate for Payer: Quartz Commercial |
$1,694.16
|
| Rate for Payer: WEA Trust Commercial |
$1,552.98
|
| Rate for Payer: WPS Commercial |
$2,091.36
|
|
|
SUTURE LASSO FIBERSTICK LT AR-4068TLF
|
Facility
|
OP
|
$2,715.00
|
|
| Hospital Charge Code |
2964719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.61 |
| Max. Negotiated Rate |
$2,597.71 |
| Rate for Payer: Aetna Commercial |
$2,541.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,428.30
|
| Rate for Payer: Aetna Managed Medicare |
$790.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,835.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.51
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,597.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,580.13
|
| Rate for Payer: Health EOS Commercial |
$2,513.00
|
| Rate for Payer: HFN Commercial |
$2,597.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.70
|
| Rate for Payer: Multiplan Commercial |
$2,258.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,694.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.56
|
| Rate for Payer: Quartz Commercial |
$1,835.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,694.16
|
| Rate for Payer: The Alliance Commercial |
$1,411.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.98
|
| Rate for Payer: WPS Commercial |
$2,091.36
|
|
|
SUTURE LASSO FIBERSTICK RT AR-4068TRF
|
Facility
|
IP
|
$2,715.00
|
|
| Hospital Charge Code |
2964720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.56 |
| Max. Negotiated Rate |
$2,597.71 |
| Rate for Payer: Aetna Commercial |
$2,541.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,428.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.51
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,597.71
|
| Rate for Payer: Health EOS Commercial |
$2,513.00
|
| Rate for Payer: HFN Commercial |
$2,597.71
|
| Rate for Payer: Multiplan Commercial |
$2,258.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.56
|
| Rate for Payer: Quartz Commercial |
$1,694.16
|
| Rate for Payer: WEA Trust Commercial |
$1,552.98
|
| Rate for Payer: WPS Commercial |
$2,091.36
|
|
|
SUTURE LASSO FIBERSTICK RT AR-4068TRF
|
Facility
|
OP
|
$2,715.00
|
|
| Hospital Charge Code |
2964720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.61 |
| Max. Negotiated Rate |
$2,597.71 |
| Rate for Payer: Aetna Commercial |
$2,541.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,428.30
|
| Rate for Payer: Aetna Managed Medicare |
$790.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,835.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.51
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna Commercial |
$2,597.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,580.13
|
| Rate for Payer: Health EOS Commercial |
$2,513.00
|
| Rate for Payer: HFN Commercial |
$2,597.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.70
|
| Rate for Payer: Multiplan Commercial |
$2,258.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,694.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.56
|
| Rate for Payer: Quartz Commercial |
$1,835.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,694.16
|
| Rate for Payer: The Alliance Commercial |
$1,411.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.98
|
| Rate for Payer: WPS Commercial |
$2,091.36
|
|
|
SUTURE LASSO MICRO AR-8701
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
SUTURE LASSO MICRO AR-8701
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
SUTURE LASSO SD WIRE LOOP AR-4068-05SD
|
Facility
|
IP
|
$628.00
|
|
| Hospital Charge Code |
5106618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.03 |
| Max. Negotiated Rate |
$600.87 |
| Rate for Payer: Aetna Commercial |
$587.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$561.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.15
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$600.87
|
| Rate for Payer: Health EOS Commercial |
$581.28
|
| Rate for Payer: HFN Commercial |
$600.87
|
| Rate for Payer: Multiplan Commercial |
$522.50
|
| Rate for Payer: Preferred Network Access Commercial |
$600.87
|
| Rate for Payer: Quartz Beloit One Network |
$320.03
|
| Rate for Payer: Quartz Commercial |
$391.87
|
| Rate for Payer: WEA Trust Commercial |
$359.22
|
| Rate for Payer: WPS Commercial |
$483.75
|
|
|
SUTURE LASSO SD WIRE LOOP AR-4068-05SD
|
Facility
|
OP
|
$628.00
|
|
| Hospital Charge Code |
5106618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.87 |
| Max. Negotiated Rate |
$600.87 |
| Rate for Payer: Aetna Commercial |
$587.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$561.68
|
| Rate for Payer: Aetna Managed Medicare |
$182.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$424.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$313.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.15
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$600.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$365.50
|
| Rate for Payer: Health EOS Commercial |
$581.28
|
| Rate for Payer: HFN Commercial |
$600.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.84
|
| Rate for Payer: Multiplan Commercial |
$522.50
|
| Rate for Payer: NAPHCARE Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$600.87
|
| Rate for Payer: Quartz Beloit One Network |
$320.03
|
| Rate for Payer: Quartz Commercial |
$424.53
|
| Rate for Payer: Quartz Medicare Advantage |
$391.87
|
| Rate for Payer: The Alliance Commercial |
$326.56
|
| Rate for Payer: WEA Trust Commercial |
$359.22
|
| Rate for Payer: WPS Commercial |
$483.75
|
|
|
SUTURE LT 45DEG SHUTTLE IDEAL 251003
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,598.62 |
| Max. Negotiated Rate |
$3,001.48 |
| Rate for Payer: Aetna Commercial |
$2,936.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,805.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,729.11
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$3,001.48
|
| Rate for Payer: Health EOS Commercial |
$2,903.61
|
| Rate for Payer: HFN Commercial |
$3,001.48
|
| Rate for Payer: Multiplan Commercial |
$2,609.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,001.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.62
|
| Rate for Payer: Quartz Commercial |
$1,957.49
|
| Rate for Payer: WEA Trust Commercial |
$1,794.36
|
| Rate for Payer: WPS Commercial |
$2,416.43
|
|
|
SUTURE LT 45DEG SHUTTLE IDEAL 251003
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$913.49 |
| Max. Negotiated Rate |
$3,001.48 |
| Rate for Payer: Aetna Commercial |
$2,936.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,805.73
|
| Rate for Payer: Aetna Managed Medicare |
$913.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,120.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,631.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,565.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,729.11
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$3,001.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,825.73
|
| Rate for Payer: Health EOS Commercial |
$2,903.61
|
| Rate for Payer: HFN Commercial |
$3,001.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,446.86
|
| Rate for Payer: Multiplan Commercial |
$2,609.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,957.49
|
| Rate for Payer: Preferred Network Access Commercial |
$3,001.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.62
|
| Rate for Payer: Quartz Commercial |
$2,120.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,957.49
|
| Rate for Payer: The Alliance Commercial |
$1,631.24
|
| Rate for Payer: WEA Trust Commercial |
$1,794.36
|
| Rate for Payer: WPS Commercial |
$2,416.43
|
|
|
SUTURE MENISCAL REPAIR 8536
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
2964885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
SUTURE MENISCAL REPAIR 8536
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
2964885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.92
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.96
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$425.57
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$425.57
|
| Rate for Payer: The Alliance Commercial |
$354.64
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
