|
Suture Set Up
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
1500801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.55 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.89
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.26
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$322.61
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$349.49
|
| Rate for Payer: Quartz Medicare Advantage |
$322.61
|
| Rate for Payer: The Alliance Commercial |
$268.84
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
SUTURE SILK 4-0 683G
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2974517
|
|
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 SILK 4-0 683G
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2974517
|
|
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 SILK 5-0 BLK PS-3 1678H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2973124
|
|
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 SILK 5-0 BLK PS-3 1678H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2973124
|
|
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 SMALL JOINT TFCC
|
Facility
|
OP
|
$2,045.00
|
|
| Hospital Charge Code |
2964960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.50 |
| Max. Negotiated Rate |
$1,956.66 |
| Rate for Payer: Aetna Commercial |
$1,914.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.05
|
| Rate for Payer: Aetna Managed Medicare |
$595.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,382.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,063.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,020.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.20
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,956.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,190.19
|
| Rate for Payer: Health EOS Commercial |
$1,892.85
|
| Rate for Payer: HFN Commercial |
$1,956.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,595.10
|
| Rate for Payer: Multiplan Commercial |
$1,701.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,276.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,956.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.13
|
| Rate for Payer: Quartz Commercial |
$1,382.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,276.08
|
| Rate for Payer: The Alliance Commercial |
$1,063.40
|
| Rate for Payer: WEA Trust Commercial |
$1,169.74
|
| Rate for Payer: WPS Commercial |
$1,575.26
|
|
|
SUTURE SMALL JOINT TFCC
|
Facility
|
IP
|
$2,045.00
|
|
| Hospital Charge Code |
2964960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.13 |
| Max. Negotiated Rate |
$1,956.66 |
| Rate for Payer: Aetna Commercial |
$1,914.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.20
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,956.66
|
| Rate for Payer: Health EOS Commercial |
$1,892.85
|
| Rate for Payer: HFN Commercial |
$1,956.66
|
| Rate for Payer: Multiplan Commercial |
$1,701.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,956.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.13
|
| Rate for Payer: Quartz Commercial |
$1,276.08
|
| Rate for Payer: WEA Trust Commercial |
$1,169.74
|
| Rate for Payer: WPS Commercial |
$1,575.26
|
|
|
SUTURE STRAIGHT SHUTTLE IDEAL 251007
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965094
|
|
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 STRAIGHT SHUTTLE IDEAL 251007
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965094
|
|
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 TAPE 1.3MM TIGERLINK WHITE/BLACK AR-7535T
|
Facility
|
OP
|
$1,466.00
|
|
| Hospital Charge Code |
5459479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.90 |
| Max. Negotiated Rate |
$1,402.67 |
| Rate for Payer: Aetna Commercial |
$1,372.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Aetna Managed Medicare |
$426.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.06
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,402.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.21
|
| Rate for Payer: Health EOS Commercial |
$1,356.93
|
| Rate for Payer: HFN Commercial |
$1,402.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.48
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: NAPHCARE Commercial |
$914.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.67
|
| Rate for Payer: Quartz Beloit One Network |
$747.07
|
| Rate for Payer: Quartz Commercial |
$991.02
|
| Rate for Payer: Quartz Medicare Advantage |
$914.78
|
| Rate for Payer: The Alliance Commercial |
$762.32
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,129.26
|
|
|
SUTURE TAPE 1.3MM TIGERLINK WHITE/BLACK AR-7535T
|
Facility
|
IP
|
$1,466.00
|
|
| Hospital Charge Code |
5459479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.07 |
| Max. Negotiated Rate |
$1,402.67 |
| Rate for Payer: Aetna Commercial |
$1,372.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.06
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,402.67
|
| Rate for Payer: Health EOS Commercial |
$1,356.93
|
| Rate for Payer: HFN Commercial |
$1,402.67
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.67
|
| Rate for Payer: Quartz Beloit One Network |
$747.07
|
| Rate for Payer: Quartz Commercial |
$914.78
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,129.26
|
|
|
SUTURE TAPE 1.3MM W/TAILS WH/ BL AR-7500
|
Facility
|
OP
|
$748.00
|
|
| Hospital Charge Code |
5190727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.82 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Aetna Managed Medicare |
$217.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.34
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.44
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: NAPHCARE Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$505.65
|
| Rate for Payer: Quartz Medicare Advantage |
$466.75
|
| Rate for Payer: The Alliance Commercial |
$388.96
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
SUTURE TAPE 1.3MM W/TAILS WH/ BL AR-7500
|
Facility
|
IP
|
$748.00
|
|
| Hospital Charge Code |
5190727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$466.75
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
SUTURE TAPE 1.3 WH/BL W/36.6 RV CT NDL AR-7502
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
5454698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SUTURE TAPE 1.3 WH/BL W/36.6 RV CT NDL AR-7502
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
5454698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SUTURE TAPE FIBERLINK 0.9 WHITE/BLUE CLOSED LOOP AR-7559
|
Facility
|
OP
|
$1,517.00
|
|
| Hospital Charge Code |
5563244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$441.75 |
| Max. Negotiated Rate |
$1,451.47 |
| Rate for Payer: Aetna Commercial |
$1,419.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,356.80
|
| Rate for Payer: Aetna Managed Medicare |
$441.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,025.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$788.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$757.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.17
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,451.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$882.89
|
| Rate for Payer: Health EOS Commercial |
$1,404.14
|
| Rate for Payer: HFN Commercial |
$1,451.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,183.26
|
| Rate for Payer: Multiplan Commercial |
$1,262.14
|
| Rate for Payer: NAPHCARE Commercial |
$946.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,451.47
|
| Rate for Payer: Quartz Beloit One Network |
$773.06
|
| Rate for Payer: Quartz Commercial |
$1,025.49
|
| Rate for Payer: Quartz Medicare Advantage |
$946.61
|
| Rate for Payer: The Alliance Commercial |
$788.84
|
| Rate for Payer: WEA Trust Commercial |
$867.72
|
| Rate for Payer: WPS Commercial |
$1,168.55
|
|
|
SUTURE TAPE FIBERLINK 0.9 WHITE/BLUE CLOSED LOOP AR-7559
|
Facility
|
IP
|
$1,517.00
|
|
| Hospital Charge Code |
5563244
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$773.06 |
| Max. Negotiated Rate |
$1,451.47 |
| Rate for Payer: Aetna Commercial |
$1,419.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,356.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.17
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,451.47
|
| Rate for Payer: Health EOS Commercial |
$1,404.14
|
| Rate for Payer: HFN Commercial |
$1,451.47
|
| Rate for Payer: Multiplan Commercial |
$1,262.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,451.47
|
| Rate for Payer: Quartz Beloit One Network |
$773.06
|
| Rate for Payer: Quartz Commercial |
$946.61
|
| Rate for Payer: WEA Trust Commercial |
$867.72
|
| Rate for Payer: WPS Commercial |
$1,168.55
|
|
|
SUTURE TAPE FIBERLINK AR-7535
|
Facility
|
IP
|
$1,356.00
|
|
| Hospital Charge Code |
5415461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$691.02 |
| Max. Negotiated Rate |
$1,297.42 |
| Rate for Payer: Aetna Commercial |
$1,269.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.43
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$1,297.42
|
| Rate for Payer: Health EOS Commercial |
$1,255.11
|
| Rate for Payer: HFN Commercial |
$1,297.42
|
| Rate for Payer: Multiplan Commercial |
$1,128.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,297.42
|
| Rate for Payer: Quartz Beloit One Network |
$691.02
|
| Rate for Payer: Quartz Commercial |
$846.14
|
| Rate for Payer: WEA Trust Commercial |
$775.63
|
| Rate for Payer: WPS Commercial |
$1,044.53
|
|
|
SUTURE TAPE FIBERLINK AR-7535
|
Facility
|
OP
|
$1,356.00
|
|
| Hospital Charge Code |
5415461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.87 |
| Max. Negotiated Rate |
$1,297.42 |
| Rate for Payer: Aetna Commercial |
$1,269.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.81
|
| Rate for Payer: Aetna Managed Medicare |
$394.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$916.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$705.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.43
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$1,297.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$789.19
|
| Rate for Payer: Health EOS Commercial |
$1,255.11
|
| Rate for Payer: HFN Commercial |
$1,297.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,057.68
|
| Rate for Payer: Multiplan Commercial |
$1,128.19
|
| Rate for Payer: NAPHCARE Commercial |
$846.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,297.42
|
| Rate for Payer: Quartz Beloit One Network |
$691.02
|
| Rate for Payer: Quartz Commercial |
$916.66
|
| Rate for Payer: Quartz Medicare Advantage |
$846.14
|
| Rate for Payer: The Alliance Commercial |
$705.12
|
| Rate for Payer: WEA Trust Commercial |
$775.63
|
| Rate for Payer: WPS Commercial |
$1,044.53
|
|
|
SUTURETAPE FIBERLOOP WITH NEEDLE WHITE/BLUE AR-7534
|
Facility
|
OP
|
$1,330.00
|
|
| Hospital Charge Code |
5414770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$1,272.54 |
| Rate for Payer: Aetna Commercial |
$1,244.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.55
|
| Rate for Payer: Aetna Managed Medicare |
$387.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$899.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$733.10
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,272.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$774.06
|
| Rate for Payer: Health EOS Commercial |
$1,231.05
|
| Rate for Payer: HFN Commercial |
$1,272.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.40
|
| Rate for Payer: Multiplan Commercial |
$1,106.56
|
| Rate for Payer: NAPHCARE Commercial |
$829.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.54
|
| Rate for Payer: Quartz Beloit One Network |
$677.77
|
| Rate for Payer: Quartz Commercial |
$899.08
|
| Rate for Payer: Quartz Medicare Advantage |
$829.92
|
| Rate for Payer: The Alliance Commercial |
$691.60
|
| Rate for Payer: WEA Trust Commercial |
$760.76
|
| Rate for Payer: WPS Commercial |
$1,024.50
|
|
|
SUTURETAPE FIBERLOOP WITH NEEDLE WHITE/BLUE AR-7534
|
Facility
|
IP
|
$1,330.00
|
|
| Hospital Charge Code |
5414770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.77 |
| Max. Negotiated Rate |
$1,272.54 |
| Rate for Payer: Aetna Commercial |
$1,244.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$733.10
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,272.54
|
| Rate for Payer: Health EOS Commercial |
$1,231.05
|
| Rate for Payer: HFN Commercial |
$1,272.54
|
| Rate for Payer: Multiplan Commercial |
$1,106.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.54
|
| Rate for Payer: Quartz Beloit One Network |
$677.77
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: WEA Trust Commercial |
$760.76
|
| Rate for Payer: WPS Commercial |
$1,024.50
|
|
|
SUTURETAPE/NEEDLES MENISCUS REPAIR 0.9MM AR-7523
|
Facility
|
OP
|
$2,196.00
|
|
| Hospital Charge Code |
5599715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.48 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Aetna Managed Medicare |
$639.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,484.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,096.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.07
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.88
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,484.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,370.30
|
| Rate for Payer: The Alliance Commercial |
$1,141.92
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
SUTURETAPE/NEEDLES MENISCUS REPAIR 0.9MM AR-7523
|
Facility
|
IP
|
$2,196.00
|
|
| Hospital Charge Code |
5599715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.08 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,370.30
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
SUTURE TIGERLOOP AR-7234T
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
4595506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.07 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$816.82
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
SUTURE TIGERLOOP AR-7234T
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
4595506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Aetna Managed Medicare |
$381.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.84
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.02
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: NAPHCARE Commercial |
$816.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$884.88
|
| Rate for Payer: Quartz Medicare Advantage |
$816.82
|
| Rate for Payer: The Alliance Commercial |
$680.68
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
