|
KIT ALLEN SHOULDER SUSPENSION A-21200-A7
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
2964624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Aetna Managed Medicare |
$205.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$676.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.31
|
| Rate for Payer: Health EOS Commercial |
$654.15
|
| Rate for Payer: HFN Commercial |
$676.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.25
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: NAPHCARE Commercial |
$441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$676.20
|
| Rate for Payer: Quartz Beloit One Network |
$360.15
|
| Rate for Payer: Quartz Commercial |
$477.75
|
| Rate for Payer: Quartz Medicare Advantage |
$441.00
|
| Rate for Payer: The Alliance Commercial |
$2,940.00
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
KIT ALLEN SHOULDER SUSPENSION A-21200-A7
|
Facility
|
IP
|
$735.00
|
|
| Hospital Charge Code |
2964624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.15 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$676.20
|
| Rate for Payer: Health EOS Commercial |
$654.15
|
| Rate for Payer: HFN Commercial |
$676.20
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: NAPHCARE Commercial |
$441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$676.20
|
| Rate for Payer: Quartz Beloit One Network |
$360.15
|
| Rate for Payer: Quartz Commercial |
$441.00
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
KIT ANCHOR FIBERTAK SUTURE AR-3600DC
|
Facility
|
OP
|
$3,535.00
|
|
| Hospital Charge Code |
4520259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.80 |
| Max. Negotiated Rate |
$14,140.00 |
| Rate for Payer: Aetna Commercial |
$3,181.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,040.10
|
| Rate for Payer: Aetna Managed Medicare |
$989.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,297.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,767.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,696.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,873.55
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$3,252.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,978.19
|
| Rate for Payer: Health EOS Commercial |
$3,146.15
|
| Rate for Payer: HFN Commercial |
$3,252.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,651.25
|
| Rate for Payer: Multiplan Commercial |
$2,828.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,121.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,252.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,732.15
|
| Rate for Payer: Quartz Commercial |
$2,297.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,121.00
|
| Rate for Payer: The Alliance Commercial |
$14,140.00
|
| Rate for Payer: WEA Trust Commercial |
$1,944.25
|
| Rate for Payer: WPS Commercial |
$2,618.37
|
|
|
KIT ANCHOR FIBERTAK SUTURE AR-3600DC
|
Facility
|
IP
|
$3,535.00
|
|
| Hospital Charge Code |
4520259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,732.15 |
| Max. Negotiated Rate |
$3,252.20 |
| Rate for Payer: Aetna Commercial |
$3,181.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,040.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,873.55
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$3,252.20
|
| Rate for Payer: Health EOS Commercial |
$3,146.15
|
| Rate for Payer: HFN Commercial |
$3,252.20
|
| Rate for Payer: Multiplan Commercial |
$2,828.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,121.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,252.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,732.15
|
| Rate for Payer: Quartz Commercial |
$2,121.00
|
| Rate for Payer: WEA Trust Commercial |
$1,944.25
|
| Rate for Payer: WPS Commercial |
$2,618.37
|
|
|
KIT ANCHOR FIBERTAK SUTURE DX W 1.3MM FIBERWIRE SUTURE TAPE & NEEDLE AR-8990DS
|
Facility
|
OP
|
$4,182.00
|
|
| Hospital Charge Code |
5583386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.96 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$3,763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,596.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,170.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,718.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,007.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,216.46
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$3,847.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,340.25
|
| Rate for Payer: Health EOS Commercial |
$3,721.98
|
| Rate for Payer: HFN Commercial |
$3,847.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,345.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,509.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,847.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,049.18
|
| Rate for Payer: Quartz Commercial |
$2,718.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,509.20
|
| Rate for Payer: The Alliance Commercial |
$16,728.00
|
| Rate for Payer: WEA Trust Commercial |
$2,300.10
|
| Rate for Payer: WPS Commercial |
$3,097.61
|
|
|
KIT ANCHOR FIBERTAK SUTURE DX W 1.3MM FIBERWIRE SUTURE TAPE & NEEDLE AR-8990DS
|
Facility
|
IP
|
$4,182.00
|
|
| Hospital Charge Code |
5583386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,049.18 |
| Max. Negotiated Rate |
$3,847.44 |
| Rate for Payer: Aetna Commercial |
$3,763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,596.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,216.46
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$3,847.44
|
| Rate for Payer: Health EOS Commercial |
$3,721.98
|
| Rate for Payer: HFN Commercial |
$3,847.44
|
| Rate for Payer: Multiplan Commercial |
$3,345.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,509.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,847.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,049.18
|
| Rate for Payer: Quartz Commercial |
$2,509.20
|
| Rate for Payer: WEA Trust Commercial |
$2,300.10
|
| Rate for Payer: WPS Commercial |
$3,097.61
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS CURVED AR-3638DC
|
Facility
|
OP
|
$2,805.00
|
|
| Hospital Charge Code |
5459089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$11,220.00 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,412.30
|
| Rate for Payer: Aetna Managed Medicare |
$785.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,823.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,402.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,346.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.65
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,580.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,569.68
|
| Rate for Payer: Health EOS Commercial |
$2,496.45
|
| Rate for Payer: HFN Commercial |
$2,580.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,103.75
|
| Rate for Payer: Multiplan Commercial |
$2,244.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,683.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,374.45
|
| Rate for Payer: Quartz Commercial |
$1,823.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,683.00
|
| Rate for Payer: The Alliance Commercial |
$11,220.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.75
|
| Rate for Payer: WPS Commercial |
$2,077.66
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS CURVED AR-3638DC
|
Facility
|
IP
|
$2,805.00
|
|
| Hospital Charge Code |
5459089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,374.45 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,412.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.65
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,580.60
|
| Rate for Payer: Health EOS Commercial |
$2,496.45
|
| Rate for Payer: HFN Commercial |
$2,580.60
|
| Rate for Payer: Multiplan Commercial |
$2,244.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,683.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,374.45
|
| Rate for Payer: Quartz Commercial |
$1,683.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.75
|
| Rate for Payer: WPS Commercial |
$2,077.66
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS STRAIGHT AR-3638DS
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
5659715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,252.93 |
| Max. Negotiated Rate |
$2,352.44 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,534.20
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS STRAIGHT AR-3638DS
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
5659715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.96 |
| Max. Negotiated Rate |
$10,228.00 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Aetna Managed Medicare |
$715.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,662.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.90
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,662.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,534.20
|
| Rate for Payer: The Alliance Commercial |
$10,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
KIT ANCHOR FIBERTAK SUTURE RC DOUBLOAD TAPE BL/W BLK/W AR-3650DS
|
Facility
|
IP
|
$2,805.00
|
|
| Hospital Charge Code |
5385071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,374.45 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,412.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.65
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,580.60
|
| Rate for Payer: Health EOS Commercial |
$2,496.45
|
| Rate for Payer: HFN Commercial |
$2,580.60
|
| Rate for Payer: Multiplan Commercial |
$2,244.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,683.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,374.45
|
| Rate for Payer: Quartz Commercial |
$1,683.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.75
|
| Rate for Payer: WPS Commercial |
$2,077.66
|
|
|
KIT ANCHOR FIBERTAK SUTURE RC DOUBLOAD TAPE BL/W BLK/W AR-3650DS
|
Facility
|
OP
|
$2,805.00
|
|
| Hospital Charge Code |
5385071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$11,220.00 |
| Rate for Payer: Aetna Commercial |
$2,524.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,412.30
|
| Rate for Payer: Aetna Managed Medicare |
$785.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,823.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,402.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,346.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.65
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,580.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,569.68
|
| Rate for Payer: Health EOS Commercial |
$2,496.45
|
| Rate for Payer: HFN Commercial |
$2,580.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,103.75
|
| Rate for Payer: Multiplan Commercial |
$2,244.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,683.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,374.45
|
| Rate for Payer: Quartz Commercial |
$1,823.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,683.00
|
| Rate for Payer: The Alliance Commercial |
$11,220.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.75
|
| Rate for Payer: WPS Commercial |
$2,077.66
|
|
|
KIT ANCHOR SWIVELOCK DX 3.5 AR-8979DS
|
Facility
|
IP
|
$4,182.00
|
|
| Hospital Charge Code |
5597552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.18 |
| Max. Negotiated Rate |
$3,847.44 |
| Rate for Payer: Aetna Commercial |
$3,763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,596.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,216.46
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$3,847.44
|
| Rate for Payer: Health EOS Commercial |
$3,721.98
|
| Rate for Payer: HFN Commercial |
$3,847.44
|
| Rate for Payer: Multiplan Commercial |
$3,345.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,509.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,847.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,049.18
|
| Rate for Payer: Quartz Commercial |
$2,509.20
|
| Rate for Payer: WEA Trust Commercial |
$2,300.10
|
| Rate for Payer: WPS Commercial |
$3,097.61
|
|
|
KIT ANCHOR SWIVELOCK DX 3.5 AR-8979DS
|
Facility
|
OP
|
$4,182.00
|
|
| Hospital Charge Code |
5597552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.96 |
| Max. Negotiated Rate |
$16,728.00 |
| Rate for Payer: Aetna Commercial |
$3,763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,596.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,170.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,718.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,007.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,216.46
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$3,847.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,340.25
|
| Rate for Payer: Health EOS Commercial |
$3,721.98
|
| Rate for Payer: HFN Commercial |
$3,847.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,345.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,509.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,847.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,049.18
|
| Rate for Payer: Quartz Commercial |
$2,718.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,509.20
|
| Rate for Payer: The Alliance Commercial |
$16,728.00
|
| Rate for Payer: WEA Trust Commercial |
$2,300.10
|
| Rate for Payer: WPS Commercial |
$3,097.61
|
|
|
KIT ANGEL PRP ARTHREX ABS-10061T
|
Facility
|
IP
|
$3,325.00
|
|
| Hospital Charge Code |
5659755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,629.25 |
| Max. Negotiated Rate |
$3,059.00 |
| Rate for Payer: Aetna Commercial |
$2,992.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.25
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cigna Commercial |
$3,059.00
|
| Rate for Payer: Health EOS Commercial |
$2,959.25
|
| Rate for Payer: HFN Commercial |
$3,059.00
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,995.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.25
|
| Rate for Payer: Quartz Commercial |
$1,995.00
|
| Rate for Payer: WEA Trust Commercial |
$1,828.75
|
| Rate for Payer: WPS Commercial |
$2,462.83
|
|
|
KIT ANGEL PRP ARTHREX ABS-10061T
|
Facility
|
OP
|
$3,325.00
|
|
| Hospital Charge Code |
5659755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.00 |
| Max. Negotiated Rate |
$13,300.00 |
| Rate for Payer: Aetna Commercial |
$2,992.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.50
|
| Rate for Payer: Aetna Managed Medicare |
$931.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,662.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.25
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cigna Commercial |
$3,059.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,860.67
|
| Rate for Payer: Health EOS Commercial |
$2,959.25
|
| Rate for Payer: HFN Commercial |
$3,059.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,493.75
|
| Rate for Payer: Multiplan Commercial |
$2,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,995.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.25
|
| Rate for Payer: Quartz Commercial |
$2,161.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,995.00
|
| Rate for Payer: The Alliance Commercial |
$13,300.00
|
| Rate for Payer: WEA Trust Commercial |
$1,828.75
|
| Rate for Payer: WPS Commercial |
$2,462.83
|
|
|
KIT ARISTA & APPLICATOR ENT ENT0001-2
|
Facility
|
OP
|
$1,777.00
|
|
| Hospital Charge Code |
4595220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.56 |
| Max. Negotiated Rate |
$7,108.00 |
| Rate for Payer: Aetna Commercial |
$1,599.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Aetna Managed Medicare |
$497.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.81
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,634.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.41
|
| Rate for Payer: Health EOS Commercial |
$1,581.53
|
| Rate for Payer: HFN Commercial |
$1,634.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.75
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.84
|
| Rate for Payer: Quartz Beloit One Network |
$870.73
|
| Rate for Payer: Quartz Commercial |
$1,155.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.20
|
| Rate for Payer: The Alliance Commercial |
$7,108.00
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
KIT ARISTA & APPLICATOR ENT ENT0001-2
|
Facility
|
IP
|
$1,777.00
|
|
| Hospital Charge Code |
4595220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.73 |
| Max. Negotiated Rate |
$1,634.84 |
| Rate for Payer: Aetna Commercial |
$1,599.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.81
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,634.84
|
| Rate for Payer: Health EOS Commercial |
$1,581.53
|
| Rate for Payer: HFN Commercial |
$1,634.84
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.84
|
| Rate for Payer: Quartz Beloit One Network |
$870.73
|
| Rate for Payer: Quartz Commercial |
$1,066.20
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
KIT ARTHREX ACP SERIES 1 ABS-10011
|
Facility
|
OP
|
$2,775.00
|
|
| Hospital Charge Code |
4169022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$11,100.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Aetna Managed Medicare |
$777.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,552.89
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,081.25
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,803.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,665.00
|
| Rate for Payer: The Alliance Commercial |
$11,100.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
KIT ARTHREX ACP SERIES 1 ABS-10011
|
Facility
|
IP
|
$2,775.00
|
|
| Hospital Charge Code |
4169022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,359.75 |
| Max. Negotiated Rate |
$2,553.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,665.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
KIT AUTOSCORE TEST FORMS
|
Facility
|
OP
|
$1,830.00
|
|
| Hospital Charge Code |
2972710
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$7,320.00 |
| Rate for Payer: Aetna Commercial |
$1,647.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.80
|
| Rate for Payer: Aetna Managed Medicare |
$512.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,189.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$915.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.90
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$1,683.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.07
|
| Rate for Payer: Health EOS Commercial |
$1,628.70
|
| Rate for Payer: HFN Commercial |
$1,683.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,372.50
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,098.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.60
|
| Rate for Payer: Quartz Beloit One Network |
$896.70
|
| Rate for Payer: Quartz Commercial |
$1,189.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,098.00
|
| Rate for Payer: The Alliance Commercial |
$7,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,006.50
|
| Rate for Payer: WPS Commercial |
$1,355.48
|
|
|
KIT AUTOSCORE TEST FORMS
|
Facility
|
IP
|
$1,830.00
|
|
| Hospital Charge Code |
2972710
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$896.70 |
| Max. Negotiated Rate |
$1,683.60 |
| Rate for Payer: Aetna Commercial |
$1,647.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.90
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$1,683.60
|
| Rate for Payer: Health EOS Commercial |
$1,628.70
|
| Rate for Payer: HFN Commercial |
$1,683.60
|
| Rate for Payer: Multiplan Commercial |
$1,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,098.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.60
|
| Rate for Payer: Quartz Beloit One Network |
$896.70
|
| Rate for Payer: Quartz Commercial |
$1,098.00
|
| Rate for Payer: WEA Trust Commercial |
$1,006.50
|
| Rate for Payer: WPS Commercial |
$1,355.48
|
|
|
KIT BIOCARTILAGE DELIVERY SYSTEM SMALL ABS-1000-S
|
Facility
|
OP
|
$2,506.00
|
|
| Hospital Charge Code |
5240720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.68 |
| Max. Negotiated Rate |
$10,024.00 |
| Rate for Payer: Aetna Commercial |
$2,255.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Aetna Managed Medicare |
$701.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,628.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,202.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,328.18
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,305.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,402.36
|
| Rate for Payer: Health EOS Commercial |
$2,230.34
|
| Rate for Payer: HFN Commercial |
$2,305.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,879.50
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,503.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,305.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.94
|
| Rate for Payer: Quartz Commercial |
$1,628.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,503.60
|
| Rate for Payer: The Alliance Commercial |
$10,024.00
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
KIT BIOCARTILAGE DELIVERY SYSTEM SMALL ABS-1000-S
|
Facility
|
IP
|
$2,506.00
|
|
| Hospital Charge Code |
5240720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,227.94 |
| Max. Negotiated Rate |
$2,305.52 |
| Rate for Payer: Aetna Commercial |
$2,255.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,328.18
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,305.52
|
| Rate for Payer: Health EOS Commercial |
$2,230.34
|
| Rate for Payer: HFN Commercial |
$2,305.52
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,503.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,305.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.94
|
| Rate for Payer: Quartz Commercial |
$1,503.60
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
KIT BIOPSY MISSION 18GX10CM 1810MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5458892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
