|
SUTURE 7-0 PROLENE 30 IN 8704H
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2965750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$32.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$69.00
|
| Rate for Payer: The Alliance Commercial |
$460.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
SUTURE 7-0 PROLENE BV-1 TAPERPOINT 30 IN BLUE DOUBLE ARM 8703H
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SUTURE 7-0 PROLENE BV-1 TAPERPOINT 30 IN BLUE DOUBLE ARM 8703H
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2965749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SUTURE 7-0 PROLENE BV-1 VB DOUBLE ARM 30 IN BLUE MS/4 EPM8703
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
5831695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.95 |
| Max. Negotiated Rate |
$1,246.60 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$813.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
SUTURE 7-0 PROLENE BV-1 VB DOUBLE ARM 30 IN BLUE MS/4 EPM8703
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
5831695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.40 |
| Max. Negotiated Rate |
$5,420.00 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Aetna Managed Medicare |
$379.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.26
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.25
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$880.75
|
| Rate for Payer: Quartz Medicare Advantage |
$813.00
|
| Rate for Payer: The Alliance Commercial |
$5,420.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
SUTURE 7-0 PROLENE M8702
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2965751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
SUTURE 7-0 PROLENE M8702
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2965751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$32.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$69.00
|
| Rate for Payer: The Alliance Commercial |
$460.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
SUTURE 7-0 VICRYL J566G
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
6171650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SUTURE 7-0 VICRYL J566G
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
6171650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SUTURE 8-0 ETHILON BV130-4 TAPER 5 IN BLACK 2815G
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2965752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SUTURE 8-0 ETHILON BV130-4 TAPER 5 IN BLACK 2815G
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SUTURE 8-0 PROLENE BV175-6 TAPER MS/2 X 24 IN DOUBLE ARM BLUE M8743
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2965753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
SUTURE 8-0 PROLENE BV175-6 TAPER MS/2 X 24 IN DOUBLE ARM BLUE M8743
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2965753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$32.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$69.00
|
| Rate for Payer: The Alliance Commercial |
$460.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
SUTURE 8-0 VICRYL BV130-5 TAPER 5 IN VIOLET J401G
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2965754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SUTURE 8-0 VICRYL BV130-5 TAPER 5 IN VIOLET J401G
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SUTURE 8-0 VICRYL J548G
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
6171651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Aetna Managed Medicare |
$78.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.69
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$182.00
|
| Rate for Payer: Quartz Medicare Advantage |
$168.00
|
| Rate for Payer: The Alliance Commercial |
$1,120.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
SUTURE 8-0 VICRYL J548G
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
6171651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
SUTURE 8-0 VICRYL TG140-8 MICRO-POINT SPATULA DOUBLE-ARM 8 IN VIOLET J401G
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2965755
|
|
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 8-0 VICRYL TG140-8 MICRO-POINT SPATULA DOUBLE-ARM 8 IN VIOLET J401G
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2965755
|
|
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 9-0 ETHILON BV130-4 5 IN BLACK 2813G
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
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 |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
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 |
$1,059.24 |
| Max. Negotiated Rate |
$15,132.00 |
| Rate for Payer: Aetna Commercial |
$3,404.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,253.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,458.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,891.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,815.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,004.99
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,480.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,116.97
|
| Rate for Payer: Health EOS Commercial |
$3,366.87
|
| Rate for Payer: HFN Commercial |
$3,480.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,837.25
|
| Rate for Payer: Multiplan Commercial |
$3,026.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,269.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,480.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,853.67
|
| Rate for Payer: Quartz Commercial |
$2,458.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,269.80
|
| Rate for Payer: The Alliance Commercial |
$15,132.00
|
| Rate for Payer: WEA Trust Commercial |
$2,080.65
|
| Rate for Payer: WPS Commercial |
$2,802.07
|
|
|
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 |
$1,853.67 |
| Max. Negotiated Rate |
$3,480.36 |
| Rate for Payer: Aetna Commercial |
$3,404.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,253.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,004.99
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,480.36
|
| Rate for Payer: Health EOS Commercial |
$3,366.87
|
| Rate for Payer: HFN Commercial |
$3,480.36
|
| Rate for Payer: Multiplan Commercial |
$3,026.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,269.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,480.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,853.67
|
| Rate for Payer: Quartz Commercial |
$2,269.80
|
| Rate for Payer: WEA Trust Commercial |
$2,080.65
|
| Rate for Payer: WPS Commercial |
$2,802.07
|
|
|
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 |
$1,228.64 |
| Max. Negotiated Rate |
$17,552.00 |
| Rate for Payer: Aetna Commercial |
$3,949.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,773.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,228.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,852.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,106.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,325.64
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,036.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,455.52
|
| Rate for Payer: Health EOS Commercial |
$3,905.32
|
| Rate for Payer: HFN Commercial |
$4,036.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,291.00
|
| Rate for Payer: Multiplan Commercial |
$3,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,632.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,036.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,150.12
|
| Rate for Payer: Quartz Commercial |
$2,852.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,632.80
|
| Rate for Payer: The Alliance Commercial |
$17,552.00
|
| Rate for Payer: WEA Trust Commercial |
$2,413.40
|
| Rate for Payer: WPS Commercial |
$3,250.19
|
|
|
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 |
$2,150.12 |
| Max. Negotiated Rate |
$4,036.96 |
| Rate for Payer: Aetna Commercial |
$3,949.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,773.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,325.64
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,036.96
|
| Rate for Payer: Health EOS Commercial |
$3,905.32
|
| Rate for Payer: HFN Commercial |
$4,036.96
|
| Rate for Payer: Multiplan Commercial |
$3,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,632.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,036.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,150.12
|
| Rate for Payer: Quartz Commercial |
$2,632.80
|
| Rate for Payer: WEA Trust Commercial |
$2,413.40
|
| Rate for Payer: WPS Commercial |
$3,250.19
|
|
