|
SUTURE 9-0 ETHILON BV130-4 5 IN BLACK 2813G
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2965756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 9-0 ETHILON BV130-4 5 IN BLACK 2813G
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW BIOCOMPOSITE AR-1941BC
|
Facility
|
IP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.82 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,360.59
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW BIOCOMPOSITE AR-1941BC
|
Facility
|
OP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.61 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,201.71
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,950.74
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,360.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,557.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,360.59
|
| Rate for Payer: The Alliance Commercial |
$1,967.16
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW PEEK AR-1941PSV
|
Facility
|
OP
|
$4,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.79 |
| Max. Negotiated Rate |
$4,198.44 |
| Rate for Payer: Aetna Commercial |
$4,107.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,924.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,277.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,966.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,281.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,190.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,418.67
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,198.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,553.82
|
| Rate for Payer: Health EOS Commercial |
$4,061.53
|
| Rate for Payer: HFN Commercial |
$4,198.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,422.64
|
| Rate for Payer: Multiplan Commercial |
$3,650.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,738.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,236.12
|
| Rate for Payer: Quartz Commercial |
$2,966.29
|
| Rate for Payer: Quartz Medicare Advantage |
$2,738.11
|
| Rate for Payer: The Alliance Commercial |
$2,281.76
|
| Rate for Payer: WEA Trust Commercial |
$2,509.94
|
| Rate for Payer: WPS Commercial |
$3,380.08
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW PEEK AR-1941PSV
|
Facility
|
IP
|
$4,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,236.12 |
| Max. Negotiated Rate |
$4,198.44 |
| Rate for Payer: Aetna Commercial |
$4,107.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,924.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,418.67
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,198.44
|
| Rate for Payer: Health EOS Commercial |
$4,061.53
|
| Rate for Payer: HFN Commercial |
$4,198.44
|
| Rate for Payer: Multiplan Commercial |
$3,650.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,236.12
|
| Rate for Payer: Quartz Commercial |
$2,738.11
|
| Rate for Payer: WEA Trust Commercial |
$2,509.94
|
| Rate for Payer: WPS Commercial |
$3,380.08
|
|
|
SUTURE BONE WAX W31G
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
2965757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.93
|
| 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: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$57.41
|
| Rate for Payer: The Alliance Commercial |
$47.84
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
SUTURE BONE WAX W31G
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
2965757
|
|
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
|
|
|
SUTURE BOOTS YELLOW DYNJSBY5
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
2965829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$48.67
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$48.67
|
| Rate for Payer: The Alliance Commercial |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
SUTURE BOOTS YELLOW DYNJSBY5
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
2965829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
SUTURE CHR GUT 3-0 1638H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2973224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CHR GUT 3-0 1638H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2973224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CHR GUT 4-0 1654G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CHR GUT 4-0 1654G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CHR GUT 5-0 1636G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CHR GUT 5-0 1636G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE CLIP LAPRA-TY XC200
|
Facility
|
OP
|
$2,807.00
|
|
| Hospital Charge Code |
2969375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.40 |
| Max. Negotiated Rate |
$2,685.74 |
| Rate for Payer: Aetna Commercial |
$2,627.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,510.58
|
| Rate for Payer: Aetna Managed Medicare |
$817.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,897.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,459.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,401.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.22
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,685.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,633.67
|
| Rate for Payer: Health EOS Commercial |
$2,598.16
|
| Rate for Payer: HFN Commercial |
$2,685.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,189.46
|
| Rate for Payer: Multiplan Commercial |
$2,335.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,751.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,685.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.45
|
| Rate for Payer: Quartz Commercial |
$1,897.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,751.57
|
| Rate for Payer: The Alliance Commercial |
$1,459.64
|
| Rate for Payer: WEA Trust Commercial |
$1,605.60
|
| Rate for Payer: WPS Commercial |
$2,162.23
|
|
|
SUTURE CLIP LAPRA-TY XC200
|
Facility
|
IP
|
$2,807.00
|
|
| Hospital Charge Code |
2969375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,430.45 |
| Max. Negotiated Rate |
$2,685.74 |
| Rate for Payer: Aetna Commercial |
$2,627.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,510.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.22
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,685.74
|
| Rate for Payer: Health EOS Commercial |
$2,598.16
|
| Rate for Payer: HFN Commercial |
$2,685.74
|
| Rate for Payer: Multiplan Commercial |
$2,335.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,685.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.45
|
| Rate for Payer: Quartz Commercial |
$1,751.57
|
| Rate for Payer: WEA Trust Commercial |
$1,605.60
|
| Rate for Payer: WPS Commercial |
$2,162.23
|
|
|
SUTURE CLOSURE DEVICE #0 V-LOC 180 ABSORBABLE TAPER GS-21 NEEDLE 12 IN VLOCL0316
|
Facility
|
IP
|
$654.00
|
|
| Hospital Charge Code |
5264654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.28 |
| Max. Negotiated Rate |
$625.75 |
| Rate for Payer: Aetna Commercial |
$612.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.48
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$625.75
|
| Rate for Payer: Health EOS Commercial |
$605.34
|
| Rate for Payer: HFN Commercial |
$625.75
|
| Rate for Payer: Multiplan Commercial |
$544.13
|
| Rate for Payer: Preferred Network Access Commercial |
$625.75
|
| Rate for Payer: Quartz Beloit One Network |
$333.28
|
| Rate for Payer: Quartz Commercial |
$408.10
|
| Rate for Payer: WEA Trust Commercial |
$374.09
|
| Rate for Payer: WPS Commercial |
$503.78
|
|
|
SUTURE CLOSURE DEVICE #0 V-LOC 180 ABSORBABLE TAPER GS-21 NEEDLE 12 IN VLOCL0316
|
Facility
|
OP
|
$654.00
|
|
| Hospital Charge Code |
5264654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.44 |
| Max. Negotiated Rate |
$625.75 |
| Rate for Payer: Aetna Commercial |
$612.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.94
|
| Rate for Payer: Aetna Managed Medicare |
$190.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.48
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$625.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.63
|
| Rate for Payer: Health EOS Commercial |
$605.34
|
| Rate for Payer: HFN Commercial |
$625.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.12
|
| Rate for Payer: Multiplan Commercial |
$544.13
|
| Rate for Payer: NAPHCARE Commercial |
$408.10
|
| Rate for Payer: Preferred Network Access Commercial |
$625.75
|
| Rate for Payer: Quartz Beloit One Network |
$333.28
|
| Rate for Payer: Quartz Commercial |
$442.10
|
| Rate for Payer: Quartz Medicare Advantage |
$408.10
|
| Rate for Payer: The Alliance Commercial |
$340.08
|
| Rate for Payer: WEA Trust Commercial |
$374.09
|
| Rate for Payer: WPS Commercial |
$503.78
|
|
|
SUTURE CLOSURE DEVICE #0 V-LOC 180 PDO CT-1/GS-21 TAPER 18 IN GREEN VL0CL0326
|
Facility
|
OP
|
$724.00
|
|
| Hospital Charge Code |
6214971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.83 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$210.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$376.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.37
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$564.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$489.42
|
| Rate for Payer: Quartz Medicare Advantage |
$451.78
|
| Rate for Payer: The Alliance Commercial |
$376.48
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
SUTURE CLOSURE DEVICE #0 V-LOC 180 PDO CT-1/GS-21 TAPER 18 IN GREEN VL0CL0326
|
Facility
|
IP
|
$724.00
|
|
| Hospital Charge Code |
6214971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.95 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$451.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
SUTURE CLOSURE DEVICE #0 V-LOC 180 PDO CTX/GS-25 TAPER 18 IN GREEN VL0CL0426
|
Facility
|
IP
|
$727.00
|
|
| Hospital Charge Code |
6214969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.48 |
| Max. Negotiated Rate |
$695.59 |
| Rate for Payer: Aetna Commercial |
$680.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$650.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.72
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$695.59
|
| Rate for Payer: Health EOS Commercial |
$672.91
|
| Rate for Payer: HFN Commercial |
$695.59
|
| Rate for Payer: Multiplan Commercial |
$604.86
|
| Rate for Payer: Preferred Network Access Commercial |
$695.59
|
| Rate for Payer: Quartz Beloit One Network |
$370.48
|
| Rate for Payer: Quartz Commercial |
$453.65
|
| Rate for Payer: WEA Trust Commercial |
$415.84
|
| Rate for Payer: WPS Commercial |
$560.01
|
|
|
SUTURE CLOSURE DEVICE #0 V-LOC 180 PDO CTX/GS-25 TAPER 18 IN GREEN VL0CL0426
|
Facility
|
OP
|
$727.00
|
|
| Hospital Charge Code |
6214969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.70 |
| Max. Negotiated Rate |
$695.59 |
| Rate for Payer: Aetna Commercial |
$680.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$650.23
|
| Rate for Payer: Aetna Managed Medicare |
$211.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$491.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$378.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$362.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.72
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$695.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$423.11
|
| Rate for Payer: Health EOS Commercial |
$672.91
|
| Rate for Payer: HFN Commercial |
$695.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$567.06
|
| Rate for Payer: Multiplan Commercial |
$604.86
|
| Rate for Payer: NAPHCARE Commercial |
$453.65
|
| Rate for Payer: Preferred Network Access Commercial |
$695.59
|
| Rate for Payer: Quartz Beloit One Network |
$370.48
|
| Rate for Payer: Quartz Commercial |
$491.45
|
| Rate for Payer: Quartz Medicare Advantage |
$453.65
|
| Rate for Payer: The Alliance Commercial |
$378.04
|
| Rate for Payer: WEA Trust Commercial |
$415.84
|
| Rate for Payer: WPS Commercial |
$560.01
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC 2 METRIC NON-ABSORBABLE C-20 NEEDLE 6 IN VLOCN0604
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
5599597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
