|
SUTURE 4-0 MONOCRYL P-3 PRECISION POINT REVERSE CUT 18 IN UNDYED Y494G
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
5809859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
SUTURE 4-0 MONOCRYL P-3 PRECISION POINT REVERSE CUT 18 IN UNDYED Y494G
|
Facility
|
OP
|
$112.00
|
|
| Hospital Charge Code |
5809859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$32.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.36
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$69.89
|
| Rate for Payer: The Alliance Commercial |
$58.24
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
SUTURE 4-0 MONOCRYL PLUS STRATAFIX RB-1 UNDYED SXMP1B434
|
Facility
|
OP
|
$567.00
|
|
| Hospital Charge Code |
5414646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$165.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$353.81
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$353.81
|
| Rate for Payer: The Alliance Commercial |
$294.84
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
SUTURE 4-0 MONOCRYL PLUS STRATAFIX RB-1 UNDYED SXMP1B434
|
Facility
|
IP
|
$567.00
|
|
| Hospital Charge Code |
5414646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
SUTURE 4-0 MONOCRYL PS-2 PRECISION POINT REVERSE CUT 18 IN UNDYED Y496G
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2965689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
SUTURE 4-0 MONOCRYL PS-2 PRECISION POINT REVERSE CUT 18 IN UNDYED Y496G
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2965689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
SUTURE 4-0 MONOCRYL PS-2 PRECISION POINT REVERSE CUT 27 IN UNDYED Y426H
|
Facility
|
OP
|
$127.00
|
|
| Hospital Charge Code |
5627640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$121.51 |
| Rate for Payer: Aetna Commercial |
$118.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.59
|
| Rate for Payer: Aetna Managed Medicare |
$36.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.00
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cigna Commercial |
$121.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.91
|
| Rate for Payer: Health EOS Commercial |
$117.55
|
| Rate for Payer: HFN Commercial |
$121.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.06
|
| Rate for Payer: Multiplan Commercial |
$105.66
|
| Rate for Payer: NAPHCARE Commercial |
$79.25
|
| Rate for Payer: Preferred Network Access Commercial |
$121.51
|
| Rate for Payer: Quartz Beloit One Network |
$64.72
|
| Rate for Payer: Quartz Commercial |
$85.85
|
| Rate for Payer: Quartz Medicare Advantage |
$79.25
|
| Rate for Payer: The Alliance Commercial |
$66.04
|
| Rate for Payer: WEA Trust Commercial |
$72.64
|
| Rate for Payer: WPS Commercial |
$97.83
|
|
|
SUTURE 4-0 MONOCRYL PS-2 PRECISION POINT REVERSE CUT 27 IN UNDYED Y426H
|
Facility
|
IP
|
$127.00
|
|
| Hospital Charge Code |
5627640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.72 |
| Max. Negotiated Rate |
$121.51 |
| Rate for Payer: Aetna Commercial |
$118.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.00
|
| Rate for Payer: Cash Price |
$38.10
|
| Rate for Payer: Cigna Commercial |
$121.51
|
| Rate for Payer: Health EOS Commercial |
$117.55
|
| Rate for Payer: HFN Commercial |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$105.66
|
| Rate for Payer: Preferred Network Access Commercial |
$121.51
|
| Rate for Payer: Quartz Beloit One Network |
$64.72
|
| Rate for Payer: Quartz Commercial |
$79.25
|
| Rate for Payer: WEA Trust Commercial |
$72.64
|
| Rate for Payer: WPS Commercial |
$97.83
|
|
|
SUTURE 4-0 NUROLON RB-1 TAPER 18 IN MS/8 BLACK BRAIDED N124T
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2965690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 4-0 NUROLON RB-1 TAPER 18 IN MS/8 BLACK BRAIDED N124T
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2965690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 4-0 NUROLON TF TAPER CR/8 18 IN BLACK BRAIDED N104
|
Facility
|
IP
|
$299.01
|
|
| Hospital Charge Code |
6246177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.38 |
| Max. Negotiated Rate |
$286.09 |
| Rate for Payer: Aetna Commercial |
$279.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$267.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.81
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cigna Commercial |
$286.09
|
| Rate for Payer: Health EOS Commercial |
$276.76
|
| Rate for Payer: HFN Commercial |
$286.09
|
| Rate for Payer: Multiplan Commercial |
$248.78
|
| Rate for Payer: Preferred Network Access Commercial |
$286.09
|
| Rate for Payer: Quartz Beloit One Network |
$152.38
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: WEA Trust Commercial |
$171.03
|
| Rate for Payer: WPS Commercial |
$230.33
|
|
|
SUTURE 4-0 NUROLON TF TAPER CR/8 18 IN BLACK BRAIDED N104
|
Facility
|
OP
|
$299.01
|
|
| Hospital Charge Code |
6246177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$286.09 |
| Rate for Payer: Aetna Commercial |
$279.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$267.43
|
| Rate for Payer: Aetna Managed Medicare |
$87.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$202.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$155.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$149.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.81
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cigna Commercial |
$286.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.02
|
| Rate for Payer: Health EOS Commercial |
$276.76
|
| Rate for Payer: HFN Commercial |
$286.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$233.23
|
| Rate for Payer: Multiplan Commercial |
$248.78
|
| Rate for Payer: NAPHCARE Commercial |
$186.58
|
| Rate for Payer: Preferred Network Access Commercial |
$286.09
|
| Rate for Payer: Quartz Beloit One Network |
$152.38
|
| Rate for Payer: Quartz Commercial |
$202.13
|
| Rate for Payer: Quartz Medicare Advantage |
$186.58
|
| Rate for Payer: The Alliance Commercial |
$155.49
|
| Rate for Payer: WEA Trust Commercial |
$171.03
|
| Rate for Payer: WPS Commercial |
$230.33
|
|
|
SUTURE 4-0 PDS CLEAR 18 IN PC-3 COSMETIC-CONVENTIONAL CUTTING Z823G
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
5831819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
SUTURE 4-0 PDS CLEAR 18 IN PC-3 COSMETIC-CONVENTIONAL CUTTING Z823G
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
5831819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$84.86
|
| Rate for Payer: The Alliance Commercial |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
SUTURE 4-0 PDS FS-2 27 IN REVERSE CUT CLEAR J422H
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2965691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 4-0 PDS FS-2 27 IN REVERSE CUT CLEAR J422H
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2965691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 4-0 PDS PS-2 REVERSE CUT 18 IN CLEAR Z496G
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
4858687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
SUTURE 4-0 PDS PS-2 REVERSE CUT 18 IN CLEAR Z496G
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
4858687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$30.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$65.52
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$65.52
|
| Rate for Payer: The Alliance Commercial |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
SUTURE 4-0 PLAIN 18 IN STR CUTTING KEITH 1824H
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2965692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
SUTURE 4-0 PLAIN 18 IN STR CUTTING KEITH 1824H
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2965692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
SUTURE 4-0 PROLENE BB TAPER POINT DOUBLE-ARM 36 IN BLUE 8581H
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2965695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
SUTURE 4-0 PROLENE BB TAPER POINT DOUBLE-ARM 36 IN BLUE 8581H
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2965695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
SUTURE 4-0 PROLENE PS-2 PRECISION POINT REVERSE CUT 18 IN BLUE 8682G
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2965696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
SUTURE 4-0 PROLENE PS-2 PRECISION POINT REVERSE CUT 18 IN BLUE 8682G
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2965696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
SUTURE 4-0 PROLENE RB-1 TAPER POINT DOUBLE-ARM 36 IN VISI-BLACK 8557H
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
2965694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
