|
SUTURE SMALL JOINT TFCC
|
Facility
|
IP
|
$2,045.00
|
|
| Hospital Charge Code |
2964960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,002.05 |
| Max. Negotiated Rate |
$1,881.40 |
| Rate for Payer: Aetna Commercial |
$1,840.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,758.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.85
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,881.40
|
| Rate for Payer: Health EOS Commercial |
$1,820.05
|
| Rate for Payer: HFN Commercial |
$1,881.40
|
| Rate for Payer: Multiplan Commercial |
$1,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.05
|
| Rate for Payer: Quartz Commercial |
$1,227.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.75
|
| Rate for Payer: WPS Commercial |
$1,514.73
|
|
|
SUTURE STRAIGHT SHUTTLE IDEAL 251007
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.36 |
| Max. Negotiated Rate |
$12,548.00 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Aetna Managed Medicare |
$878.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,039.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.47
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.75
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$2,039.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,882.20
|
| Rate for Payer: The Alliance Commercial |
$12,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
SUTURE STRAIGHT SHUTTLE IDEAL 251007
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.13 |
| Max. Negotiated Rate |
$2,886.04 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$1,882.20
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
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 |
$718.34 |
| Max. Negotiated Rate |
$1,348.72 |
| Rate for Payer: Aetna Commercial |
$1,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.98
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,348.72
|
| Rate for Payer: Health EOS Commercial |
$1,304.74
|
| Rate for Payer: HFN Commercial |
$1,348.72
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.72
|
| Rate for Payer: Quartz Beloit One Network |
$718.34
|
| Rate for Payer: Quartz Commercial |
$879.60
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
|
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 |
$410.48 |
| Max. Negotiated Rate |
$5,864.00 |
| Rate for Payer: Aetna Commercial |
$1,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Aetna Managed Medicare |
$410.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$952.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$703.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.98
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,348.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.37
|
| Rate for Payer: Health EOS Commercial |
$1,304.74
|
| Rate for Payer: HFN Commercial |
$1,348.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,099.50
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.72
|
| Rate for Payer: Quartz Beloit One Network |
$718.34
|
| Rate for Payer: Quartz Commercial |
$952.90
|
| Rate for Payer: Quartz Medicare Advantage |
$879.60
|
| Rate for Payer: The Alliance Commercial |
$5,864.00
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
|
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 |
$209.44 |
| Max. Negotiated Rate |
$2,992.00 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.58
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$486.20
|
| Rate for Payer: Quartz Medicare Advantage |
$448.80
|
| Rate for Payer: The Alliance Commercial |
$2,992.00
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
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 |
$366.52 |
| Max. Negotiated Rate |
$688.16 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$448.80
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
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 |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$424.76 |
| Max. Negotiated Rate |
$6,068.00 |
| Rate for Payer: Aetna Commercial |
$1,365.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.62
|
| Rate for Payer: Aetna Managed Medicare |
$424.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$986.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$728.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.01
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,395.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.91
|
| Rate for Payer: Health EOS Commercial |
$1,350.13
|
| Rate for Payer: HFN Commercial |
$1,395.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,137.75
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.64
|
| Rate for Payer: Quartz Beloit One Network |
$743.33
|
| Rate for Payer: Quartz Commercial |
$986.05
|
| Rate for Payer: Quartz Medicare Advantage |
$910.20
|
| Rate for Payer: The Alliance Commercial |
$6,068.00
|
| Rate for Payer: WEA Trust Commercial |
$834.35
|
| Rate for Payer: WPS Commercial |
$1,123.64
|
|
|
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 |
$743.33 |
| Max. Negotiated Rate |
$1,395.64 |
| Rate for Payer: Aetna Commercial |
$1,365.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.01
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,395.64
|
| Rate for Payer: Health EOS Commercial |
$1,350.13
|
| Rate for Payer: HFN Commercial |
$1,395.64
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.64
|
| Rate for Payer: Quartz Beloit One Network |
$743.33
|
| Rate for Payer: Quartz Commercial |
$910.20
|
| Rate for Payer: WEA Trust Commercial |
$834.35
|
| Rate for Payer: WPS Commercial |
$1,123.64
|
|
|
SUTURE TAPE FIBERLINK AR-7535
|
Facility
|
OP
|
$1,356.00
|
|
| Hospital Charge Code |
5415461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.68 |
| Max. Negotiated Rate |
$5,424.00 |
| Rate for Payer: Aetna Commercial |
$1,220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,166.16
|
| Rate for Payer: Aetna Managed Medicare |
$379.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$881.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$678.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.68
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$1,247.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.82
|
| Rate for Payer: Health EOS Commercial |
$1,206.84
|
| Rate for Payer: HFN Commercial |
$1,247.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,017.00
|
| Rate for Payer: Multiplan Commercial |
$1,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$813.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,247.52
|
| Rate for Payer: Quartz Beloit One Network |
$664.44
|
| Rate for Payer: Quartz Commercial |
$881.40
|
| Rate for Payer: Quartz Medicare Advantage |
$813.60
|
| Rate for Payer: The Alliance Commercial |
$5,424.00
|
| Rate for Payer: WEA Trust Commercial |
$745.80
|
| Rate for Payer: WPS Commercial |
$1,004.39
|
|
|
SUTURE TAPE FIBERLINK AR-7535
|
Facility
|
IP
|
$1,356.00
|
|
| Hospital Charge Code |
5415461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.44 |
| Max. Negotiated Rate |
$1,247.52 |
| Rate for Payer: Aetna Commercial |
$1,220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,166.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.68
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$1,247.52
|
| Rate for Payer: Health EOS Commercial |
$1,206.84
|
| Rate for Payer: HFN Commercial |
$1,247.52
|
| Rate for Payer: Multiplan Commercial |
$1,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$813.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,247.52
|
| Rate for Payer: Quartz Beloit One Network |
$664.44
|
| Rate for Payer: Quartz Commercial |
$813.60
|
| Rate for Payer: WEA Trust Commercial |
$745.80
|
| Rate for Payer: WPS Commercial |
$1,004.39
|
|
|
SUTURETAPE FIBERLOOP WITH NEEDLE WHITE/BLUE AR-7534
|
Facility
|
IP
|
$1,330.00
|
|
| Hospital Charge Code |
5414770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.70 |
| Max. Negotiated Rate |
$1,223.60 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$798.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SUTURETAPE FIBERLOOP WITH NEEDLE WHITE/BLUE AR-7534
|
Facility
|
OP
|
$1,330.00
|
|
| Hospital Charge Code |
5414770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$5,320.00 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Aetna Managed Medicare |
$372.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$864.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.27
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$864.50
|
| Rate for Payer: Quartz Medicare Advantage |
$798.00
|
| Rate for Payer: The Alliance Commercial |
$5,320.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SUTURETAPE/NEEDLES MENISCUS REPAIR 0.9MM AR-7523
|
Facility
|
IP
|
$2,196.00
|
|
| Hospital Charge Code |
5599715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SUTURETAPE/NEEDLES MENISCUS REPAIR 0.9MM AR-7523
|
Facility
|
OP
|
$2,196.00
|
|
| Hospital Charge Code |
5599715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SUTURE TIGERLOOP AR-7234T
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
4595506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.41 |
| Max. Negotiated Rate |
$1,204.28 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$785.40
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
SUTURE TIGERLOOP AR-7234T
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
4595506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$5,236.00 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Aetna Managed Medicare |
$366.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.52
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.75
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$850.85
|
| Rate for Payer: Quartz Medicare Advantage |
$785.40
|
| Rate for Payer: The Alliance Commercial |
$5,236.00
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
SUTURE TIGERSTICK #2 AR-7209T
|
Facility
|
OP
|
$1,306.00
|
|
| Hospital Charge Code |
5307085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.68 |
| Max. Negotiated Rate |
$5,224.00 |
| Rate for Payer: Aetna Commercial |
$1,175.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.16
|
| Rate for Payer: Aetna Managed Medicare |
$365.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.18
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cigna Commercial |
$1,201.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.84
|
| Rate for Payer: Health EOS Commercial |
$1,162.34
|
| Rate for Payer: HFN Commercial |
$1,201.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.50
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.52
|
| Rate for Payer: Quartz Beloit One Network |
$639.94
|
| Rate for Payer: Quartz Commercial |
$848.90
|
| Rate for Payer: Quartz Medicare Advantage |
$783.60
|
| Rate for Payer: The Alliance Commercial |
$5,224.00
|
| Rate for Payer: WEA Trust Commercial |
$718.30
|
| Rate for Payer: WPS Commercial |
$967.35
|
|
|
SUTURE TIGERSTICK #2 AR-7209T
|
Facility
|
IP
|
$1,306.00
|
|
| Hospital Charge Code |
5307085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.94 |
| Max. Negotiated Rate |
$1,201.52 |
| Rate for Payer: Aetna Commercial |
$1,175.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.18
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cigna Commercial |
$1,201.52
|
| Rate for Payer: Health EOS Commercial |
$1,162.34
|
| Rate for Payer: HFN Commercial |
$1,201.52
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.52
|
| Rate for Payer: Quartz Beloit One Network |
$639.94
|
| Rate for Payer: Quartz Commercial |
$783.60
|
| Rate for Payer: WEA Trust Commercial |
$718.30
|
| Rate for Payer: WPS Commercial |
$967.35
|
|
|
SUTURE TIGHTROPE TWIN TAIL
|
Facility
|
OP
|
$5,263.00
|
|
| Hospital Charge Code |
2964704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.64 |
| Max. Negotiated Rate |
$21,052.00 |
| Rate for Payer: Aetna Commercial |
$4,736.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,526.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,420.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,631.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,526.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,789.39
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$4,841.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,945.17
|
| Rate for Payer: Health EOS Commercial |
$4,684.07
|
| Rate for Payer: HFN Commercial |
$4,841.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,947.25
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.87
|
| Rate for Payer: Quartz Commercial |
$3,420.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,157.80
|
| Rate for Payer: The Alliance Commercial |
$21,052.00
|
| Rate for Payer: WEA Trust Commercial |
$2,894.65
|
| Rate for Payer: WPS Commercial |
$3,898.30
|
|
|
SUTURE TIGHTROPE TWIN TAIL
|
Facility
|
IP
|
$5,263.00
|
|
| Hospital Charge Code |
2964704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,578.87 |
| Max. Negotiated Rate |
$4,841.96 |
| Rate for Payer: Aetna Commercial |
$4,736.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,526.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,789.39
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$4,841.96
|
| Rate for Payer: Health EOS Commercial |
$4,684.07
|
| Rate for Payer: HFN Commercial |
$4,841.96
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.87
|
| Rate for Payer: Quartz Commercial |
$3,157.80
|
| Rate for Payer: WEA Trust Commercial |
$2,894.65
|
| Rate for Payer: WPS Commercial |
$3,898.30
|
|
|
SUTURE UMBILICAL TAPE U11T
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2965759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
SUTURE UMBILICAL TAPE U11T
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2965759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
