|
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
|
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 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 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 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 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 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 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 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 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
|
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 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 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
|
|
|
SUTURE NOVAFIL,BLUE 6-0
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974719
|
|
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 NOVAFIL,BLUE 6-0
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974719
|
|
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 NYLON 697G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974181
|
|
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 NYLON 697G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974181
|
|
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 OF DIGITAL NERVE, HAND OR FOOT; 1 NERVE
|
Facility
|
OP
|
$12,727.52
|
|
|
Service Code
|
CPT 64831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$12,727.52 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 64832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,057.64 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: The Alliance Commercial |
$1,057.64
|
|
