SUTURE #0 VICRYL UR-6 27 IN VIOLET UR-6 J603H
|
Facility
IP
|
$74.00
|
|
Hospital Charge Code |
5240648
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$36.26 |
Max. Negotiated Rate |
$68.08 |
Rate for Payer: Aetna Commercial |
$66.60
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
Rate for Payer: Cash Price |
$22.20
|
Rate for Payer: Cigna Commercial |
$68.08
|
Rate for Payer: Health EOS Commercial |
$65.86
|
Rate for Payer: HFN Commercial |
$68.08
|
Rate for Payer: Multiplan Commercial |
$59.20
|
Rate for Payer: NAPHCARE Commercial |
$44.40
|
Rate for Payer: Preferred Network Access Commercial |
$68.08
|
Rate for Payer: Quartz Beloit One Network |
$36.26
|
Rate for Payer: Quartz Commercial |
$44.40
|
Rate for Payer: WEA Trust Commercial |
$40.70
|
Rate for Payer: WPS Commercial |
$54.81
|
|
SUTURE #0 VICRYL UR-6 27 IN VIOLET UR-6 J603H
|
Facility
OP
|
$74.00
|
|
Hospital Charge Code |
5240648
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$20.72 |
Max. Negotiated Rate |
$296.00 |
Rate for Payer: Aetna Commercial |
$66.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
Rate for Payer: Aetna Managed Medicare |
$20.72
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.10
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.52
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
Rate for Payer: Cash Price |
$22.20
|
Rate for Payer: Cigna Commercial |
$68.08
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
Rate for Payer: Health EOS Commercial |
$65.86
|
Rate for Payer: HFN Commercial |
$68.08
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.50
|
Rate for Payer: Multiplan Commercial |
$59.20
|
Rate for Payer: NAPHCARE Commercial |
$44.40
|
Rate for Payer: Preferred Network Access Commercial |
$68.08
|
Rate for Payer: Quartz Beloit One Network |
$36.26
|
Rate for Payer: Quartz Commercial |
$48.10
|
Rate for Payer: Quartz Medicare Advantage |
$44.40
|
Rate for Payer: The Alliance Commercial |
$296.00
|
Rate for Payer: WEA Trust Commercial |
$40.70
|
Rate for Payer: WPS Commercial |
$54.81
|
|
SUTURE 10-0 ETHILON 7757G
|
Facility
IP
|
$92.00
|
|
Hospital Charge Code |
2965612
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$45.08 |
Max. Negotiated Rate |
$84.64 |
Rate for Payer: Aetna Commercial |
$82.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
Rate for Payer: Cash Price |
$27.60
|
Rate for Payer: Cigna Commercial |
$84.64
|
Rate for Payer: Health EOS Commercial |
$81.88
|
Rate for Payer: HFN Commercial |
$84.64
|
Rate for Payer: Multiplan Commercial |
$73.60
|
Rate for Payer: NAPHCARE Commercial |
$55.20
|
Rate for Payer: Preferred Network Access Commercial |
$84.64
|
Rate for Payer: Quartz Beloit One Network |
$45.08
|
Rate for Payer: Quartz Commercial |
$55.20
|
Rate for Payer: WEA Trust Commercial |
$50.60
|
Rate for Payer: WPS Commercial |
$68.14
|
|
SUTURE 10-0 ETHILON 7757G
|
Facility
OP
|
$92.00
|
|
Hospital Charge Code |
2965612
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$25.76 |
Max. Negotiated Rate |
$368.00 |
Rate for Payer: Aetna Commercial |
$82.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
Rate for Payer: Aetna Managed Medicare |
$25.76
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.16
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
Rate for Payer: Cash Price |
$27.60
|
Rate for Payer: Cigna Commercial |
$84.64
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
Rate for Payer: Health EOS Commercial |
$81.88
|
Rate for Payer: HFN Commercial |
$84.64
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.00
|
Rate for Payer: Multiplan Commercial |
$73.60
|
Rate for Payer: NAPHCARE Commercial |
$55.20
|
Rate for Payer: Preferred Network Access Commercial |
$84.64
|
Rate for Payer: Quartz Beloit One Network |
$45.08
|
Rate for Payer: Quartz Commercial |
$59.80
|
Rate for Payer: Quartz Medicare Advantage |
$55.20
|
Rate for Payer: The Alliance Commercial |
$368.00
|
Rate for Payer: WEA Trust Commercial |
$50.60
|
Rate for Payer: WPS Commercial |
$68.14
|
|
SUTURE #1 CHROMIC GUT BP ETHIGUARD BLUNT TIP 27 IN 48G
|
Facility
IP
|
$26.00
|
|
Hospital Charge Code |
2965583
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$12.74 |
Max. Negotiated Rate |
$23.92 |
Rate for Payer: Aetna Commercial |
$23.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
Rate for Payer: Cash Price |
$7.80
|
Rate for Payer: Cigna Commercial |
$23.92
|
Rate for Payer: Health EOS Commercial |
$23.14
|
Rate for Payer: HFN Commercial |
$23.92
|
Rate for Payer: Multiplan Commercial |
$20.80
|
Rate for Payer: NAPHCARE Commercial |
$15.60
|
Rate for Payer: Preferred Network Access Commercial |
$23.92
|
Rate for Payer: Quartz Beloit One Network |
$12.74
|
Rate for Payer: Quartz Commercial |
$15.60
|
Rate for Payer: WEA Trust Commercial |
$14.30
|
Rate for Payer: WPS Commercial |
$19.26
|
|
SUTURE #1 CHROMIC GUT BP ETHIGUARD BLUNT TIP 27 IN 48G
|
Facility
OP
|
$26.00
|
|
Hospital Charge Code |
2965583
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.28 |
Max. Negotiated Rate |
$104.00 |
Rate for Payer: Aetna Commercial |
$23.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
Rate for Payer: Aetna Managed Medicare |
$7.28
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
Rate for Payer: Cash Price |
$7.80
|
Rate for Payer: Cigna Commercial |
$23.92
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
Rate for Payer: Health EOS Commercial |
$23.14
|
Rate for Payer: HFN Commercial |
$23.92
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
Rate for Payer: Multiplan Commercial |
$20.80
|
Rate for Payer: NAPHCARE Commercial |
$15.60
|
Rate for Payer: Preferred Network Access Commercial |
$23.92
|
Rate for Payer: Quartz Beloit One Network |
$12.74
|
Rate for Payer: Quartz Commercial |
$16.90
|
Rate for Payer: Quartz Medicare Advantage |
$15.60
|
Rate for Payer: The Alliance Commercial |
$104.00
|
Rate for Payer: WEA Trust Commercial |
$14.30
|
Rate for Payer: WPS Commercial |
$19.26
|
|
SUTURE #1 CHROMIC GUT CT-1 TAPER POINT 36 IN 925H
|
Facility
IP
|
$26.00
|
|
Hospital Charge Code |
2965582
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$12.74 |
Max. Negotiated Rate |
$23.92 |
Rate for Payer: Aetna Commercial |
$23.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
Rate for Payer: Cash Price |
$7.80
|
Rate for Payer: Cigna Commercial |
$23.92
|
Rate for Payer: Health EOS Commercial |
$23.14
|
Rate for Payer: HFN Commercial |
$23.92
|
Rate for Payer: Multiplan Commercial |
$20.80
|
Rate for Payer: NAPHCARE Commercial |
$15.60
|
Rate for Payer: Preferred Network Access Commercial |
$23.92
|
Rate for Payer: Quartz Beloit One Network |
$12.74
|
Rate for Payer: Quartz Commercial |
$15.60
|
Rate for Payer: WEA Trust Commercial |
$14.30
|
Rate for Payer: WPS Commercial |
$19.26
|
|
SUTURE #1 CHROMIC GUT CT-1 TAPER POINT 36 IN 925H
|
Facility
OP
|
$26.00
|
|
Hospital Charge Code |
2965582
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.28 |
Max. Negotiated Rate |
$104.00 |
Rate for Payer: Aetna Commercial |
$23.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
Rate for Payer: Aetna Managed Medicare |
$7.28
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
Rate for Payer: Cash Price |
$7.80
|
Rate for Payer: Cigna Commercial |
$23.92
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
Rate for Payer: Health EOS Commercial |
$23.14
|
Rate for Payer: HFN Commercial |
$23.92
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
Rate for Payer: Multiplan Commercial |
$20.80
|
Rate for Payer: NAPHCARE Commercial |
$15.60
|
Rate for Payer: Preferred Network Access Commercial |
$23.92
|
Rate for Payer: Quartz Beloit One Network |
$12.74
|
Rate for Payer: Quartz Commercial |
$16.90
|
Rate for Payer: Quartz Medicare Advantage |
$15.60
|
Rate for Payer: The Alliance Commercial |
$104.00
|
Rate for Payer: WEA Trust Commercial |
$14.30
|
Rate for Payer: WPS Commercial |
$19.26
|
|
SUTURE #1 CHROMIC GUT CT-1 TAPER POINT CR/8-18 IN CC40G
|
Facility
OP
|
$25.00
|
|
Hospital Charge Code |
2965584
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.00 |
Max. Negotiated Rate |
$100.00 |
Rate for Payer: Aetna Commercial |
$22.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
Rate for Payer: Aetna Managed Medicare |
$7.00
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
Rate for Payer: Cash Price |
$7.50
|
Rate for Payer: Cigna Commercial |
$23.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
Rate for Payer: Health EOS Commercial |
$22.25
|
Rate for Payer: HFN Commercial |
$23.00
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
Rate for Payer: Multiplan Commercial |
$20.00
|
Rate for Payer: NAPHCARE Commercial |
$15.00
|
Rate for Payer: Preferred Network Access Commercial |
$23.00
|
Rate for Payer: Quartz Beloit One Network |
$12.25
|
Rate for Payer: Quartz Commercial |
$16.25
|
Rate for Payer: Quartz Medicare Advantage |
$15.00
|
Rate for Payer: The Alliance Commercial |
$100.00
|
Rate for Payer: WEA Trust Commercial |
$13.75
|
Rate for Payer: WPS Commercial |
$18.52
|
|
SUTURE #1 CHROMIC GUT CT-1 TAPER POINT CR/8-18 IN CC40G
|
Facility
IP
|
$25.00
|
|
Hospital Charge Code |
2965584
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$12.25 |
Max. Negotiated Rate |
$23.00 |
Rate for Payer: Aetna Commercial |
$22.50
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
Rate for Payer: Cash Price |
$7.50
|
Rate for Payer: Cigna Commercial |
$23.00
|
Rate for Payer: Health EOS Commercial |
$22.25
|
Rate for Payer: HFN Commercial |
$23.00
|
Rate for Payer: Multiplan Commercial |
$20.00
|
Rate for Payer: NAPHCARE Commercial |
$15.00
|
Rate for Payer: Preferred Network Access Commercial |
$23.00
|
Rate for Payer: Quartz Beloit One Network |
$12.25
|
Rate for Payer: Quartz Commercial |
$15.00
|
Rate for Payer: WEA Trust Commercial |
$13.75
|
Rate for Payer: WPS Commercial |
$18.52
|
|
SUTURE #1 ETHIBOND CT-1 TAPER POINT 30 IN GREEN BRAID X425H
|
Facility
IP
|
$75.00
|
|
Hospital Charge Code |
2965585
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$36.75 |
Max. Negotiated Rate |
$69.00 |
Rate for Payer: Aetna Commercial |
$67.50
|
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 #1 ETHIBOND CT-1 TAPER POINT 30 IN GREEN BRAID X425H
|
Facility
OP
|
$75.00
|
|
Hospital Charge Code |
2965585
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$21.00 |
Max. Negotiated Rate |
$300.00 |
Rate for Payer: Aetna Managed Medicare |
$21.00
|
Rate for Payer: Aetna Commercial |
$67.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
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
|
|
SUTURE #1 ETHILON CXT TAPER POINT 30 IN BLACK 830H
|
Facility
OP
|
$72.00
|
|
Hospital Charge Code |
2965587
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$20.16 |
Max. Negotiated Rate |
$288.00 |
Rate for Payer: Aetna Commercial |
$64.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
Rate for Payer: Aetna Managed Medicare |
$20.16
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
Rate for Payer: Cash Price |
$21.60
|
Rate for Payer: Cigna Commercial |
$66.24
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
Rate for Payer: Health EOS Commercial |
$64.08
|
Rate for Payer: HFN Commercial |
$66.24
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
Rate for Payer: Multiplan Commercial |
$57.60
|
Rate for Payer: NAPHCARE Commercial |
$43.20
|
Rate for Payer: Preferred Network Access Commercial |
$66.24
|
Rate for Payer: Quartz Beloit One Network |
$35.28
|
Rate for Payer: Quartz Commercial |
$46.80
|
Rate for Payer: Quartz Medicare Advantage |
$43.20
|
Rate for Payer: The Alliance Commercial |
$288.00
|
Rate for Payer: WEA Trust Commercial |
$39.60
|
Rate for Payer: WPS Commercial |
$53.33
|
|
SUTURE #1 ETHILON CXT TAPER POINT 30 IN BLACK 830H
|
Facility
IP
|
$72.00
|
|
Hospital Charge Code |
2965587
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$35.28 |
Max. Negotiated Rate |
$66.24 |
Rate for Payer: Aetna Commercial |
$64.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
Rate for Payer: Cash Price |
$21.60
|
Rate for Payer: Cigna Commercial |
$66.24
|
Rate for Payer: Health EOS Commercial |
$64.08
|
Rate for Payer: HFN Commercial |
$66.24
|
Rate for Payer: Multiplan Commercial |
$57.60
|
Rate for Payer: NAPHCARE Commercial |
$43.20
|
Rate for Payer: Preferred Network Access Commercial |
$66.24
|
Rate for Payer: Quartz Beloit One Network |
$35.28
|
Rate for Payer: Quartz Commercial |
$43.20
|
Rate for Payer: WEA Trust Commercial |
$39.60
|
Rate for Payer: WPS Commercial |
$53.33
|
|
SUTURE #1 ETHILON TP-1 TAPER POINT 60 IN BLACK 824G
|
Facility
OP
|
$75.00
|
|
Hospital Charge Code |
2965586
|
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
|
|
SUTURE #1 ETHILON TP-1 TAPER POINT 60 IN BLACK 824G
|
Facility
IP
|
$75.00
|
|
Hospital Charge Code |
2965586
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$36.75 |
Max. Negotiated Rate |
$69.00 |
Rate for Payer: Aetna Commercial |
$67.50
|
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 #1 MONOCRYL CT-1 TAPER POINT 27 IN VIOLET Y341H
|
Facility
OP
|
$80.00
|
|
Hospital Charge Code |
4858657
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$22.40 |
Max. Negotiated Rate |
$320.00 |
Rate for Payer: Aetna Commercial |
$72.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
Rate for Payer: Aetna Managed Medicare |
$22.40
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cigna Commercial |
$73.60
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
Rate for Payer: Health EOS Commercial |
$71.20
|
Rate for Payer: HFN Commercial |
$73.60
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
Rate for Payer: Multiplan Commercial |
$64.00
|
Rate for Payer: NAPHCARE Commercial |
$48.00
|
Rate for Payer: Preferred Network Access Commercial |
$73.60
|
Rate for Payer: Quartz Beloit One Network |
$39.20
|
Rate for Payer: Quartz Commercial |
$52.00
|
Rate for Payer: Quartz Medicare Advantage |
$48.00
|
Rate for Payer: The Alliance Commercial |
$320.00
|
Rate for Payer: WEA Trust Commercial |
$44.00
|
Rate for Payer: WPS Commercial |
$59.26
|
|
SUTURE #1 MONOCRYL CT-1 TAPER POINT 27 IN VIOLET Y341H
|
Facility
IP
|
$80.00
|
|
Hospital Charge Code |
4858657
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$39.20 |
Max. Negotiated Rate |
$73.60 |
Rate for Payer: Aetna Commercial |
$72.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
Rate for Payer: Cash Price |
$24.00
|
Rate for Payer: Cigna Commercial |
$73.60
|
Rate for Payer: Health EOS Commercial |
$71.20
|
Rate for Payer: HFN Commercial |
$73.60
|
Rate for Payer: Multiplan Commercial |
$64.00
|
Rate for Payer: NAPHCARE Commercial |
$48.00
|
Rate for Payer: Preferred Network Access Commercial |
$73.60
|
Rate for Payer: Quartz Beloit One Network |
$39.20
|
Rate for Payer: Quartz Commercial |
$48.00
|
Rate for Payer: WEA Trust Commercial |
$44.00
|
Rate for Payer: WPS Commercial |
$59.26
|
|
SUTURE #1 NUROLON CT-1 TAPERPOINT 30 IN BLACK 5425H
|
Facility
IP
|
$75.00
|
|
Hospital Charge Code |
2965589
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$36.75 |
Max. Negotiated Rate |
$69.00 |
Rate for Payer: Aetna Commercial |
$67.50
|
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 #1 NUROLON CT-1 TAPERPOINT 30 IN BLACK 5425H
|
Facility
OP
|
$75.00
|
|
Hospital Charge Code |
2965589
|
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
|
|
SUTURE #1 PDO STRATAFIX SPIRAL VIOLET MO-4 36CM BIDIRECTIONAL SXPD2B400
|
Facility
IP
|
$407.00
|
|
Hospital Charge Code |
5685638
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$199.43 |
Max. Negotiated Rate |
$374.44 |
Rate for Payer: Aetna Commercial |
$366.30
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
Rate for Payer: Cash Price |
$122.10
|
Rate for Payer: Cigna Commercial |
$374.44
|
Rate for Payer: Health EOS Commercial |
$362.23
|
Rate for Payer: HFN Commercial |
$374.44
|
Rate for Payer: Multiplan Commercial |
$325.60
|
Rate for Payer: NAPHCARE Commercial |
$244.20
|
Rate for Payer: Preferred Network Access Commercial |
$374.44
|
Rate for Payer: Quartz Beloit One Network |
$199.43
|
Rate for Payer: Quartz Commercial |
$244.20
|
Rate for Payer: WEA Trust Commercial |
$223.85
|
Rate for Payer: WPS Commercial |
$301.46
|
|
SUTURE #1 PDO STRATAFIX SPIRAL VIOLET MO-4 36CM BIDIRECTIONAL SXPD2B400
|
Facility
OP
|
$407.00
|
|
Hospital Charge Code |
5685638
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$113.96 |
Max. Negotiated Rate |
$1,628.00 |
Rate for Payer: Aetna Commercial |
$366.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
Rate for Payer: Aetna Managed Medicare |
$113.96
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.55
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.36
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
Rate for Payer: Cash Price |
$122.10
|
Rate for Payer: Cigna Commercial |
$374.44
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$227.76
|
Rate for Payer: Health EOS Commercial |
$362.23
|
Rate for Payer: HFN Commercial |
$374.44
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$305.25
|
Rate for Payer: Multiplan Commercial |
$325.60
|
Rate for Payer: NAPHCARE Commercial |
$244.20
|
Rate for Payer: Preferred Network Access Commercial |
$374.44
|
Rate for Payer: Quartz Beloit One Network |
$199.43
|
Rate for Payer: Quartz Commercial |
$264.55
|
Rate for Payer: Quartz Medicare Advantage |
$244.20
|
Rate for Payer: The Alliance Commercial |
$1,628.00
|
Rate for Payer: WEA Trust Commercial |
$223.85
|
Rate for Payer: WPS Commercial |
$301.46
|
|
SUTURE #1 PDS CTX TAPER 36 IN VIOLET Z371T
|
Facility
OP
|
$115.00
|
|
Hospital Charge Code |
2965590
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$32.20 |
Max. Negotiated Rate |
$460.00 |
Rate for Payer: Aetna Commercial |
$103.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
Rate for Payer: Aetna Managed Medicare |
$32.20
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.75
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
Rate for Payer: Cash Price |
$34.50
|
Rate for Payer: Cigna Commercial |
$105.80
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
Rate for Payer: Health EOS Commercial |
$102.35
|
Rate for Payer: HFN Commercial |
$105.80
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.25
|
Rate for Payer: Multiplan Commercial |
$92.00
|
Rate for Payer: NAPHCARE Commercial |
$69.00
|
Rate for Payer: Preferred Network Access Commercial |
$105.80
|
Rate for Payer: Quartz Beloit One Network |
$56.35
|
Rate for Payer: Quartz Commercial |
$74.75
|
Rate for Payer: Quartz Medicare Advantage |
$69.00
|
Rate for Payer: The Alliance Commercial |
$460.00
|
Rate for Payer: WEA Trust Commercial |
$63.25
|
Rate for Payer: WPS Commercial |
$85.18
|
|
SUTURE #1 PDS CTX TAPER 36 IN VIOLET Z371T
|
Facility
IP
|
$115.00
|
|
Hospital Charge Code |
2965590
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$56.35 |
Max. Negotiated Rate |
$105.80 |
Rate for Payer: Aetna Commercial |
$103.50
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
Rate for Payer: Cash Price |
$34.50
|
Rate for Payer: Cigna Commercial |
$105.80
|
Rate for Payer: Health EOS Commercial |
$102.35
|
Rate for Payer: HFN Commercial |
$105.80
|
Rate for Payer: Multiplan Commercial |
$92.00
|
Rate for Payer: NAPHCARE Commercial |
$69.00
|
Rate for Payer: Preferred Network Access Commercial |
$105.80
|
Rate for Payer: Quartz Beloit One Network |
$56.35
|
Rate for Payer: Quartz Commercial |
$69.00
|
Rate for Payer: WEA Trust Commercial |
$63.25
|
Rate for Payer: WPS Commercial |
$85.18
|
|
SUTURE #1 PDS PLUS PDP371T
|
Facility
IP
|
$111.00
|
|
Hospital Charge Code |
2966142
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$54.39 |
Max. Negotiated Rate |
$102.12 |
Rate for Payer: Aetna Commercial |
$99.90
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
Rate for Payer: Cash Price |
$33.30
|
Rate for Payer: Cigna Commercial |
$102.12
|
Rate for Payer: Health EOS Commercial |
$98.79
|
Rate for Payer: HFN Commercial |
$102.12
|
Rate for Payer: Multiplan Commercial |
$88.80
|
Rate for Payer: NAPHCARE Commercial |
$66.60
|
Rate for Payer: Preferred Network Access Commercial |
$102.12
|
Rate for Payer: Quartz Beloit One Network |
$54.39
|
Rate for Payer: Quartz Commercial |
$66.60
|
Rate for Payer: WEA Trust Commercial |
$61.05
|
Rate for Payer: WPS Commercial |
$82.22
|
|