|
SUTURE NOVAFIL,BLUE 6-0
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974719
|
|
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 NOVAFIL,BLUE 6-0
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974719
|
|
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 NYLON 697G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974181
|
|
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 NYLON 697G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974181
|
|
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 Of Recent Wound, Eyelid
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
1190831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.75 |
| Max. Negotiated Rate |
$1,625.26 |
| Rate for Payer: Aetna Commercial |
$1,625.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,471.29
|
| Rate for Payer: Aetna Managed Medicare |
$193.75
|
| Rate for Payer: Anthem Medicare Advantage |
$193.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.75
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna Commercial |
$1,625.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$336.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.75
|
| Rate for Payer: Health EOS Commercial |
$1,556.83
|
| Rate for Payer: HFN Commercial |
$1,625.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.75
|
| Rate for Payer: Multiplan Commercial |
$1,368.64
|
| Rate for Payer: NAPHCARE Commercial |
$290.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.26
|
| Rate for Payer: Quartz Beloit One Network |
$752.75
|
| Rate for Payer: Quartz Commercial |
$975.16
|
| Rate for Payer: Quartz Medicare Advantage |
$193.75
|
| Rate for Payer: The Alliance Commercial |
$823.45
|
| Rate for Payer: United Healthcare Medicaid |
$336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.75
|
| Rate for Payer: WEA Trust Commercial |
$940.94
|
| Rate for Payer: WPS Commercial |
$871.88
|
|
|
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATED ULCER, DIVERTICULUM, WOUND, INJURY OR RUPTURE; SINGLE PERFORATION
|
Facility
|
OP
|
$16,229.82
|
|
|
Service Code
|
CPT 44602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,057.46 |
| Max. Negotiated Rate |
$16,229.82 |
| Rate for Payer: Aetna Managed Medicare |
$4,057.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$4,057.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,057.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,057.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,057.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,057.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,093.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,057.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,057.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,057.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,057.46
|
| Rate for Payer: NAPHCARE Commercial |
$6,086.18
|
| Rate for Payer: Quartz Medicare Advantage |
$4,057.46
|
| Rate for Payer: The Alliance Commercial |
$16,229.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,057.46
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$4,057.46
|
|
|
SUTURE PASSER BLUE MEDIUM 9893
|
Facility
|
OP
|
$1,124.00
|
|
| Hospital Charge Code |
2964887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.31 |
| Max. Negotiated Rate |
$1,075.44 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Aetna Managed Medicare |
$327.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$759.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$584.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$561.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.55
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,075.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$654.17
|
| Rate for Payer: Health EOS Commercial |
$1,040.37
|
| Rate for Payer: HFN Commercial |
$1,075.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$876.72
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: NAPHCARE Commercial |
$701.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.44
|
| Rate for Payer: Quartz Beloit One Network |
$572.79
|
| Rate for Payer: Quartz Commercial |
$759.82
|
| Rate for Payer: Quartz Medicare Advantage |
$701.38
|
| Rate for Payer: The Alliance Commercial |
$584.48
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: WPS Commercial |
$865.82
|
|
|
SUTURE PASSER BLUE MEDIUM 9893
|
Facility
|
IP
|
$1,124.00
|
|
| Hospital Charge Code |
2964887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.79 |
| Max. Negotiated Rate |
$1,075.44 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.55
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,075.44
|
| Rate for Payer: Health EOS Commercial |
$1,040.37
|
| Rate for Payer: HFN Commercial |
$1,075.44
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.44
|
| Rate for Payer: Quartz Beloit One Network |
$572.79
|
| Rate for Payer: Quartz Commercial |
$701.38
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: WPS Commercial |
$865.82
|
|
|
SUTURE PASSER GREEN LARGE 9894
|
Facility
|
OP
|
$1,082.00
|
|
| Hospital Charge Code |
2964886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Aetna Managed Medicare |
$315.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$731.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$540.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.72
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.96
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: NAPHCARE Commercial |
$675.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$731.43
|
| Rate for Payer: Quartz Medicare Advantage |
$675.17
|
| Rate for Payer: The Alliance Commercial |
$562.64
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
|
SUTURE PASSER GREEN LARGE 9894
|
Facility
|
IP
|
$1,082.00
|
|
| Hospital Charge Code |
2964886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.39 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$675.17
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
|
SUTURE PASSER SWIFTSTITCH HIP AR-4068HL
|
Facility
|
OP
|
$3,649.00
|
|
| Hospital Charge Code |
5459478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,062.59 |
| Max. Negotiated Rate |
$3,491.36 |
| Rate for Payer: Aetna Commercial |
$3,415.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,263.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,062.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,466.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,897.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,821.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,011.33
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,123.72
|
| Rate for Payer: Health EOS Commercial |
$3,377.51
|
| Rate for Payer: HFN Commercial |
$3,491.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,846.22
|
| Rate for Payer: Multiplan Commercial |
$3,035.97
|
| Rate for Payer: NAPHCARE Commercial |
$2,276.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.53
|
| Rate for Payer: Quartz Commercial |
$2,466.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,276.98
|
| Rate for Payer: The Alliance Commercial |
$1,897.48
|
| Rate for Payer: WEA Trust Commercial |
$2,087.23
|
| Rate for Payer: WPS Commercial |
$2,810.82
|
|
|
SUTURE PASSER SWIFTSTITCH HIP AR-4068HL
|
Facility
|
IP
|
$3,649.00
|
|
| Hospital Charge Code |
5459478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,859.53 |
| Max. Negotiated Rate |
$3,491.36 |
| Rate for Payer: Aetna Commercial |
$3,415.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,263.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,011.33
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,491.36
|
| Rate for Payer: Health EOS Commercial |
$3,377.51
|
| Rate for Payer: HFN Commercial |
$3,491.36
|
| Rate for Payer: Multiplan Commercial |
$3,035.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.53
|
| Rate for Payer: Quartz Commercial |
$2,276.98
|
| Rate for Payer: WEA Trust Commercial |
$2,087.23
|
| Rate for Payer: WPS Commercial |
$2,810.82
|
|
|
SUTURE PASSER YELLOW SMALL 9892
|
Facility
|
OP
|
$1,124.00
|
|
| Hospital Charge Code |
2965531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.31 |
| Max. Negotiated Rate |
$1,075.44 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Aetna Managed Medicare |
$327.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$759.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$584.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$561.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.55
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,075.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$654.17
|
| Rate for Payer: Health EOS Commercial |
$1,040.37
|
| Rate for Payer: HFN Commercial |
$1,075.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$876.72
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: NAPHCARE Commercial |
$701.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.44
|
| Rate for Payer: Quartz Beloit One Network |
$572.79
|
| Rate for Payer: Quartz Commercial |
$759.82
|
| Rate for Payer: Quartz Medicare Advantage |
$701.38
|
| Rate for Payer: The Alliance Commercial |
$584.48
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: WPS Commercial |
$865.82
|
|
|
SUTURE PASSER YELLOW SMALL 9892
|
Facility
|
IP
|
$1,124.00
|
|
| Hospital Charge Code |
2965531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.79 |
| Max. Negotiated Rate |
$1,075.44 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.55
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,075.44
|
| Rate for Payer: Health EOS Commercial |
$1,040.37
|
| Rate for Payer: HFN Commercial |
$1,075.44
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.44
|
| Rate for Payer: Quartz Beloit One Network |
$572.79
|
| Rate for Payer: Quartz Commercial |
$701.38
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: WPS Commercial |
$865.82
|
|
|
SUTURE PROLENE 3-0 8687H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2973144
|
|
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 PROLENE 3-0 8687H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2973144
|
|
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 PROLENE 4-0 8619G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974717
|
|
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 PROLENE 4-0 8619G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974717
|
|
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 PROLENE 4-0 FS2 #8683G
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2969546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| 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: 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 PROLENE 4-0 FS2 #8683G
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2969546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| 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 |
$7.50
|
| 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 |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
SUTURE REMOVAL KIT MDS708555
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2963426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
SUTURE REMOVAL KIT MDS708555
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2963426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
SUTURE RT 45DEG SHUTTLE IDEAL 251004
|
Facility
|
OP
|
$3,137.00
|
|
| Hospital Charge Code |
2965093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$913.49 |
| Max. Negotiated Rate |
$3,001.48 |
| Rate for Payer: Aetna Commercial |
$2,936.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,805.73
|
| Rate for Payer: Aetna Managed Medicare |
$913.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,120.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,631.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,565.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,729.11
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$3,001.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,825.73
|
| Rate for Payer: Health EOS Commercial |
$2,903.61
|
| Rate for Payer: HFN Commercial |
$3,001.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,446.86
|
| Rate for Payer: Multiplan Commercial |
$2,609.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,957.49
|
| Rate for Payer: Preferred Network Access Commercial |
$3,001.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.62
|
| Rate for Payer: Quartz Commercial |
$2,120.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,957.49
|
| Rate for Payer: The Alliance Commercial |
$1,631.24
|
| Rate for Payer: WEA Trust Commercial |
$1,794.36
|
| Rate for Payer: WPS Commercial |
$2,416.43
|
|
|
SUTURE RT 45DEG SHUTTLE IDEAL 251004
|
Facility
|
IP
|
$3,137.00
|
|
| Hospital Charge Code |
2965093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,598.62 |
| Max. Negotiated Rate |
$3,001.48 |
| Rate for Payer: Aetna Commercial |
$2,936.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,805.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,729.11
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$3,001.48
|
| Rate for Payer: Health EOS Commercial |
$2,903.61
|
| Rate for Payer: HFN Commercial |
$3,001.48
|
| Rate for Payer: Multiplan Commercial |
$2,609.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,001.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.62
|
| Rate for Payer: Quartz Commercial |
$1,957.49
|
| Rate for Payer: WEA Trust Commercial |
$1,794.36
|
| Rate for Payer: WPS Commercial |
$2,416.43
|
|
|
Suture Set Up
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
1500801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$263.46 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$322.61
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
