|
SUTURE PASSER YELLOW SMALL 9892
|
Facility
|
OP
|
$1,124.00
|
|
| Hospital Charge Code |
2965531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.72 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna Commercial |
$1,011.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.64
|
| Rate for Payer: Aetna Managed Medicare |
$314.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$730.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$539.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.72
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,034.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$628.99
|
| Rate for Payer: Health EOS Commercial |
$1,000.36
|
| Rate for Payer: HFN Commercial |
$1,034.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$899.20
|
| Rate for Payer: NAPHCARE Commercial |
$674.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.08
|
| Rate for Payer: Quartz Beloit One Network |
$550.76
|
| Rate for Payer: Quartz Commercial |
$730.60
|
| Rate for Payer: Quartz Medicare Advantage |
$674.40
|
| Rate for Payer: The Alliance Commercial |
$4,496.00
|
| Rate for Payer: WEA Trust Commercial |
$618.20
|
| Rate for Payer: WPS Commercial |
$832.55
|
|
|
SUTURE PROLENE 3-0 8687H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2973144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| 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: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| 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 |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE PROLENE 3-0 8687H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2973144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| 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
|
|
|
SUTURE PROLENE 4-0 8619G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| 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
|
|
|
SUTURE PROLENE 4-0 8619G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| 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: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| 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 |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE PROLENE 4-0 FS2 #8683G
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2969546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| 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 PROLENE 4-0 FS2 #8683G
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2969546
|
|
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 REMOVAL KIT MDS708555
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2963426
|
|
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 REMOVAL KIT MDS708555
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2963426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| 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 RT 45DEG SHUTTLE IDEAL 251004
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.36 |
| Max. Negotiated Rate |
$12,548.00 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Aetna Managed Medicare |
$878.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,039.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.47
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.75
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$2,039.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,882.20
|
| Rate for Payer: The Alliance Commercial |
$12,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
SUTURE RT 45DEG SHUTTLE IDEAL 251004
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.13 |
| Max. Negotiated Rate |
$2,886.04 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$1,882.20
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
Suture Set Up
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
1500801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$2,068.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.75
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$336.05
|
| Rate for Payer: Quartz Medicare Advantage |
$310.20
|
| Rate for Payer: The Alliance Commercial |
$2,068.00
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
Suture Set Up
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
1500801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$310.20
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
SUTURE SILK 4-0 683G
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2974517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| 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 SILK 4-0 683G
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2974517
|
|
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 SILK 5-0 BLK PS-3 1678H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2973124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| 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: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| 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 |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE SILK 5-0 BLK PS-3 1678H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2973124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| 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
|
|
|
SUTURE SMALL JOINT TFCC
|
Facility
|
IP
|
$2,045.00
|
|
| Hospital Charge Code |
2964960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,002.05 |
| Max. Negotiated Rate |
$1,881.40 |
| Rate for Payer: Aetna Commercial |
$1,840.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,758.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.85
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,881.40
|
| Rate for Payer: Health EOS Commercial |
$1,820.05
|
| Rate for Payer: HFN Commercial |
$1,881.40
|
| Rate for Payer: Multiplan Commercial |
$1,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.05
|
| Rate for Payer: Quartz Commercial |
$1,227.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.75
|
| Rate for Payer: WPS Commercial |
$1,514.73
|
|
|
SUTURE SMALL JOINT TFCC
|
Facility
|
OP
|
$2,045.00
|
|
| Hospital Charge Code |
2964960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.60 |
| Max. Negotiated Rate |
$8,180.00 |
| Rate for Payer: Aetna Commercial |
$1,840.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,758.70
|
| Rate for Payer: Aetna Managed Medicare |
$572.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,022.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$981.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.85
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,881.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.38
|
| Rate for Payer: Health EOS Commercial |
$1,820.05
|
| Rate for Payer: HFN Commercial |
$1,881.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.75
|
| Rate for Payer: Multiplan Commercial |
$1,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.05
|
| Rate for Payer: Quartz Commercial |
$1,329.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.00
|
| Rate for Payer: The Alliance Commercial |
$8,180.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.75
|
| Rate for Payer: WPS Commercial |
$1,514.73
|
|
|
SUTURE STRAIGHT SHUTTLE IDEAL 251007
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,537.13 |
| Max. Negotiated Rate |
$2,886.04 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$1,882.20
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
SUTURE STRAIGHT SHUTTLE IDEAL 251007
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.36 |
| Max. Negotiated Rate |
$12,548.00 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Aetna Managed Medicare |
$878.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,039.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.47
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.75
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$2,039.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,882.20
|
| Rate for Payer: The Alliance Commercial |
$12,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
SUTURE TAPE 1.3MM TIGERLINK WHITE/BLACK AR-7535T
|
Facility
|
OP
|
$1,466.00
|
|
| Hospital Charge Code |
5459479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.48 |
| Max. Negotiated Rate |
$5,864.00 |
| Rate for Payer: Aetna Commercial |
$1,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Aetna Managed Medicare |
$410.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$952.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$703.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.98
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,348.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.37
|
| Rate for Payer: Health EOS Commercial |
$1,304.74
|
| Rate for Payer: HFN Commercial |
$1,348.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,099.50
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.72
|
| Rate for Payer: Quartz Beloit One Network |
$718.34
|
| Rate for Payer: Quartz Commercial |
$952.90
|
| Rate for Payer: Quartz Medicare Advantage |
$879.60
|
| Rate for Payer: The Alliance Commercial |
$5,864.00
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
|
SUTURE TAPE 1.3MM TIGERLINK WHITE/BLACK AR-7535T
|
Facility
|
IP
|
$1,466.00
|
|
| Hospital Charge Code |
5459479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$1,348.72 |
| Rate for Payer: Aetna Commercial |
$1,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.98
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,348.72
|
| Rate for Payer: Health EOS Commercial |
$1,304.74
|
| Rate for Payer: HFN Commercial |
$1,348.72
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.72
|
| Rate for Payer: Quartz Beloit One Network |
$718.34
|
| Rate for Payer: Quartz Commercial |
$879.60
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
|
SUTURE TAPE 1.3MM W/TAILS WH/ BL AR-7500
|
Facility
|
IP
|
$748.00
|
|
| Hospital Charge Code |
5190727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$688.16 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$448.80
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
SUTURE TAPE 1.3MM W/TAILS WH/ BL AR-7500
|
Facility
|
OP
|
$748.00
|
|
| Hospital Charge Code |
5190727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$2,992.00 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.58
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$486.20
|
| Rate for Payer: Quartz Medicare Advantage |
$448.80
|
| Rate for Payer: The Alliance Commercial |
$2,992.00
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
