|
KIT ANCHOR FIBERTAK SUTURE AR-3600DC
|
Facility
|
OP
|
$3,535.00
|
|
| Hospital Charge Code |
4520259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.39 |
| Max. Negotiated Rate |
$3,382.29 |
| Rate for Payer: Aetna Commercial |
$3,308.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,161.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,029.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,389.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,838.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,764.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,948.49
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$3,382.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,057.37
|
| Rate for Payer: Health EOS Commercial |
$3,272.00
|
| Rate for Payer: HFN Commercial |
$3,382.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,757.30
|
| Rate for Payer: Multiplan Commercial |
$2,941.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,205.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,382.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,801.44
|
| Rate for Payer: Quartz Commercial |
$2,389.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,205.84
|
| Rate for Payer: The Alliance Commercial |
$1,838.20
|
| Rate for Payer: WEA Trust Commercial |
$2,022.02
|
| Rate for Payer: WPS Commercial |
$2,723.01
|
|
|
KIT ANCHOR FIBERTAK SUTURE AR-3600DC
|
Facility
|
IP
|
$3,535.00
|
|
| Hospital Charge Code |
4520259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,801.44 |
| Max. Negotiated Rate |
$3,382.29 |
| Rate for Payer: Aetna Commercial |
$3,308.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,161.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,948.49
|
| Rate for Payer: Cash Price |
$1,060.50
|
| Rate for Payer: Cigna Commercial |
$3,382.29
|
| Rate for Payer: Health EOS Commercial |
$3,272.00
|
| Rate for Payer: HFN Commercial |
$3,382.29
|
| Rate for Payer: Multiplan Commercial |
$2,941.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,382.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,801.44
|
| Rate for Payer: Quartz Commercial |
$2,205.84
|
| Rate for Payer: WEA Trust Commercial |
$2,022.02
|
| Rate for Payer: WPS Commercial |
$2,723.01
|
|
|
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 |
$2,131.15 |
| Max. Negotiated Rate |
$4,001.34 |
| Rate for Payer: Aetna Commercial |
$3,914.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,740.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,305.12
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$4,001.34
|
| Rate for Payer: Health EOS Commercial |
$3,870.86
|
| Rate for Payer: HFN Commercial |
$4,001.34
|
| Rate for Payer: Multiplan Commercial |
$3,479.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,001.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,131.15
|
| Rate for Payer: Quartz Commercial |
$2,609.57
|
| Rate for Payer: WEA Trust Commercial |
$2,392.10
|
| Rate for Payer: WPS Commercial |
$3,221.39
|
|
|
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 |
$1,217.80 |
| Max. Negotiated Rate |
$4,001.34 |
| Rate for Payer: Aetna Commercial |
$3,914.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,740.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,217.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,827.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,305.12
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$4,001.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.92
|
| Rate for Payer: Health EOS Commercial |
$3,870.86
|
| Rate for Payer: HFN Commercial |
$4,001.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,261.96
|
| Rate for Payer: Multiplan Commercial |
$3,479.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,609.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,001.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,131.15
|
| Rate for Payer: Quartz Commercial |
$2,827.03
|
| Rate for Payer: Quartz Medicare Advantage |
$2,609.57
|
| Rate for Payer: The Alliance Commercial |
$2,174.64
|
| Rate for Payer: WEA Trust Commercial |
$2,392.10
|
| Rate for Payer: WPS Commercial |
$3,221.39
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS CURVED AR-3638DC
|
Facility
|
IP
|
$2,805.00
|
|
| Hospital Charge Code |
5459089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,429.43 |
| Max. Negotiated Rate |
$2,683.82 |
| Rate for Payer: Aetna Commercial |
$2,625.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,508.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,546.12
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,683.82
|
| Rate for Payer: Health EOS Commercial |
$2,596.31
|
| Rate for Payer: HFN Commercial |
$2,683.82
|
| Rate for Payer: Multiplan Commercial |
$2,333.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,683.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,429.43
|
| Rate for Payer: Quartz Commercial |
$1,750.32
|
| Rate for Payer: WEA Trust Commercial |
$1,604.46
|
| Rate for Payer: WPS Commercial |
$2,160.69
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS CURVED AR-3638DC
|
Facility
|
OP
|
$2,805.00
|
|
| Hospital Charge Code |
5459089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.82 |
| Max. Negotiated Rate |
$2,683.82 |
| Rate for Payer: Aetna Commercial |
$2,625.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,508.79
|
| Rate for Payer: Aetna Managed Medicare |
$816.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,896.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,458.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,400.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,546.12
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,683.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,632.51
|
| Rate for Payer: Health EOS Commercial |
$2,596.31
|
| Rate for Payer: HFN Commercial |
$2,683.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.90
|
| Rate for Payer: Multiplan Commercial |
$2,333.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,750.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,683.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,429.43
|
| Rate for Payer: Quartz Commercial |
$1,896.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,750.32
|
| Rate for Payer: The Alliance Commercial |
$1,458.60
|
| Rate for Payer: WEA Trust Commercial |
$1,604.46
|
| Rate for Payer: WPS Commercial |
$2,160.69
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS STRAIGHT AR-3638DS
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
5659715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.05 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,595.57
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
KIT ANCHOR FIBERTAK SUTURE KNOTLESS STRAIGHT AR-3638DS
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
5659715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Aetna Managed Medicare |
$744.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.17
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.46
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,728.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.57
|
| Rate for Payer: The Alliance Commercial |
$1,329.64
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
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 |
$816.82 |
| Max. Negotiated Rate |
$2,683.82 |
| Rate for Payer: Aetna Commercial |
$2,625.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,508.79
|
| Rate for Payer: Aetna Managed Medicare |
$816.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,896.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,458.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,400.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,546.12
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,683.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,632.51
|
| Rate for Payer: Health EOS Commercial |
$2,596.31
|
| Rate for Payer: HFN Commercial |
$2,683.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.90
|
| Rate for Payer: Multiplan Commercial |
$2,333.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,750.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,683.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,429.43
|
| Rate for Payer: Quartz Commercial |
$1,896.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,750.32
|
| Rate for Payer: The Alliance Commercial |
$1,458.60
|
| Rate for Payer: WEA Trust Commercial |
$1,604.46
|
| Rate for Payer: WPS Commercial |
$2,160.69
|
|
|
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 |
$1,429.43 |
| Max. Negotiated Rate |
$2,683.82 |
| Rate for Payer: Aetna Commercial |
$2,625.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,508.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,546.12
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna Commercial |
$2,683.82
|
| Rate for Payer: Health EOS Commercial |
$2,596.31
|
| Rate for Payer: HFN Commercial |
$2,683.82
|
| Rate for Payer: Multiplan Commercial |
$2,333.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,683.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,429.43
|
| Rate for Payer: Quartz Commercial |
$1,750.32
|
| Rate for Payer: WEA Trust Commercial |
$1,604.46
|
| Rate for Payer: WPS Commercial |
$2,160.69
|
|
|
KIT ANCHOR SWIVELOCK DX 3.5 AR-8979DS
|
Facility
|
IP
|
$4,182.00
|
|
| Hospital Charge Code |
5597552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.15 |
| Max. Negotiated Rate |
$4,001.34 |
| Rate for Payer: Aetna Commercial |
$3,914.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,740.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,305.12
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$4,001.34
|
| Rate for Payer: Health EOS Commercial |
$3,870.86
|
| Rate for Payer: HFN Commercial |
$4,001.34
|
| Rate for Payer: Multiplan Commercial |
$3,479.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,001.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,131.15
|
| Rate for Payer: Quartz Commercial |
$2,609.57
|
| Rate for Payer: WEA Trust Commercial |
$2,392.10
|
| Rate for Payer: WPS Commercial |
$3,221.39
|
|
|
KIT ANCHOR SWIVELOCK DX 3.5 AR-8979DS
|
Facility
|
OP
|
$4,182.00
|
|
| Hospital Charge Code |
5597552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.80 |
| Max. Negotiated Rate |
$4,001.34 |
| Rate for Payer: Aetna Commercial |
$3,914.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,740.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,217.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,827.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,305.12
|
| Rate for Payer: Cash Price |
$1,254.60
|
| Rate for Payer: Cigna Commercial |
$4,001.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.92
|
| Rate for Payer: Health EOS Commercial |
$3,870.86
|
| Rate for Payer: HFN Commercial |
$4,001.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,261.96
|
| Rate for Payer: Multiplan Commercial |
$3,479.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,609.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,001.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,131.15
|
| Rate for Payer: Quartz Commercial |
$2,827.03
|
| Rate for Payer: Quartz Medicare Advantage |
$2,609.57
|
| Rate for Payer: The Alliance Commercial |
$2,174.64
|
| Rate for Payer: WEA Trust Commercial |
$2,392.10
|
| Rate for Payer: WPS Commercial |
$3,221.39
|
|
|
KIT ANGEL PRP ARTHREX ABS-10061T
|
Facility
|
OP
|
$3,325.00
|
|
| Hospital Charge Code |
5659755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$3,181.36 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| Rate for Payer: Aetna Managed Medicare |
$968.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,247.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,729.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,935.15
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,247.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,074.80
|
| Rate for Payer: The Alliance Commercial |
$1,729.00
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.25
|
|
|
KIT ANGEL PRP ARTHREX ABS-10061T
|
Facility
|
IP
|
$3,325.00
|
|
| Hospital Charge Code |
5659755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,694.42 |
| Max. Negotiated Rate |
$3,181.36 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,074.80
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.25
|
|
|
KIT ARISTA & APPLICATOR ENT ENT0001-2
|
Facility
|
OP
|
$1,777.00
|
|
| Hospital Charge Code |
4595220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$517.46 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$517.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,201.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$924.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$887.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.21
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,386.06
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,108.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,201.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,108.85
|
| Rate for Payer: The Alliance Commercial |
$924.04
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
KIT ARISTA & APPLICATOR ENT ENT0001-2
|
Facility
|
IP
|
$1,777.00
|
|
| Hospital Charge Code |
4595220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$905.56 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,108.85
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
KIT ARTHREX ACP SERIES 1 ABS-10011
|
Facility
|
IP
|
$2,775.00
|
|
| Hospital Charge Code |
4169022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,414.14 |
| Max. Negotiated Rate |
$2,655.12 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,529.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,655.12
|
| Rate for Payer: Health EOS Commercial |
$2,568.54
|
| Rate for Payer: HFN Commercial |
$2,655.12
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.14
|
| Rate for Payer: Quartz Commercial |
$1,731.60
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
KIT ARTHREX ACP SERIES 1 ABS-10011
|
Facility
|
OP
|
$2,775.00
|
|
| Hospital Charge Code |
4169022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$808.08 |
| Max. Negotiated Rate |
$2,655.12 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Aetna Managed Medicare |
$808.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,875.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,385.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,529.58
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,655.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,615.05
|
| Rate for Payer: Health EOS Commercial |
$2,568.54
|
| Rate for Payer: HFN Commercial |
$2,655.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,164.50
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,731.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.14
|
| Rate for Payer: Quartz Commercial |
$1,875.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,731.60
|
| Rate for Payer: The Alliance Commercial |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
KIT AUTOSCORE TEST FORMS
|
Facility
|
IP
|
$1,830.00
|
|
| Hospital Charge Code |
2972710
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$932.57 |
| Max. Negotiated Rate |
$1,750.94 |
| Rate for Payer: Aetna Commercial |
$1,712.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.70
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$1,750.94
|
| Rate for Payer: Health EOS Commercial |
$1,693.85
|
| Rate for Payer: HFN Commercial |
$1,750.94
|
| Rate for Payer: Multiplan Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,750.94
|
| Rate for Payer: Quartz Beloit One Network |
$932.57
|
| Rate for Payer: Quartz Commercial |
$1,141.92
|
| Rate for Payer: WEA Trust Commercial |
$1,046.76
|
| Rate for Payer: WPS Commercial |
$1,409.65
|
|
|
KIT AUTOSCORE TEST FORMS
|
Facility
|
OP
|
$1,830.00
|
|
| Hospital Charge Code |
2972710
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$532.90 |
| Max. Negotiated Rate |
$1,750.94 |
| Rate for Payer: Aetna Commercial |
$1,712.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.75
|
| Rate for Payer: Aetna Managed Medicare |
$532.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$951.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.70
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$1,750.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.06
|
| Rate for Payer: Health EOS Commercial |
$1,693.85
|
| Rate for Payer: HFN Commercial |
$1,750.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.40
|
| Rate for Payer: Multiplan Commercial |
$1,522.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,750.94
|
| Rate for Payer: Quartz Beloit One Network |
$932.57
|
| Rate for Payer: Quartz Commercial |
$1,237.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,141.92
|
| Rate for Payer: The Alliance Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$1,046.76
|
| Rate for Payer: WPS Commercial |
$1,409.65
|
|
|
KIT BIOCARTILAGE DELIVERY SYSTEM SMALL ABS-1000-S
|
Facility
|
IP
|
$2,506.00
|
|
| Hospital Charge Code |
5240720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.06 |
| Max. Negotiated Rate |
$2,397.74 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,563.74
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
KIT BIOCARTILAGE DELIVERY SYSTEM SMALL ABS-1000-S
|
Facility
|
OP
|
$2,506.00
|
|
| Hospital Charge Code |
5240720
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$729.75 |
| Max. Negotiated Rate |
$2,397.74 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$729.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,694.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,303.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,458.49
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,954.68
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,563.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,694.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,563.74
|
| Rate for Payer: The Alliance Commercial |
$1,303.12
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
KIT BIOPSY MISSION 18GX10CM 1810MSK
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
5458892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.33 |
| Max. Negotiated Rate |
$930.01 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$606.53
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
KIT BIOPSY MISSION 18GX10CM 1810MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5458892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$930.01 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Aetna Managed Medicare |
$283.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$505.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.70
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.16
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: NAPHCARE Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$657.07
|
| Rate for Payer: Quartz Medicare Advantage |
$606.53
|
| Rate for Payer: The Alliance Commercial |
$505.44
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
KIT BIOPSY MISSION 18GX16CM 1816MSK
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
5458893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$930.01 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Aetna Managed Medicare |
$283.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$505.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.70
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.16
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: NAPHCARE Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$657.07
|
| Rate for Payer: Quartz Medicare Advantage |
$606.53
|
| Rate for Payer: The Alliance Commercial |
$505.44
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
