|
SUTURE BONE WAX W31G
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
2965757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$25.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$55.20
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
SUTURE BONE WAX W31G
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
2965757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
SUTURE BOOTS YELLOW DYNJSBY5
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
2965829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$312.00 |
| 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 |
$23.40
|
| 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 |
$312.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE BOOTS YELLOW DYNJSBY5
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
2965829
|
|
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 |
$23.40
|
| 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: 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 |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE CHR GUT 3-0 1638H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2973224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE CHR GUT 3-0 1638H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2973224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE CHR GUT 4-0 1654G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE CHR GUT 4-0 1654G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE CHR GUT 5-0 1636G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE CHR GUT 5-0 1636G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974693
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
SUTURE CLIP LAPRA-TY XC200
|
Facility
|
OP
|
$2,807.00
|
|
| Hospital Charge Code |
2969375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$785.96 |
| Max. Negotiated Rate |
$11,228.00 |
| Rate for Payer: Aetna Commercial |
$2,526.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.02
|
| Rate for Payer: Aetna Managed Medicare |
$785.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,824.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,403.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,347.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.71
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,582.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,570.80
|
| Rate for Payer: Health EOS Commercial |
$2,498.23
|
| Rate for Payer: HFN Commercial |
$2,582.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,105.25
|
| Rate for Payer: Multiplan Commercial |
$2,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.43
|
| Rate for Payer: Quartz Commercial |
$1,824.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.20
|
| Rate for Payer: The Alliance Commercial |
$11,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,543.85
|
| Rate for Payer: WPS Commercial |
$2,079.14
|
|
|
SUTURE CLIP LAPRA-TY XC200
|
Facility
|
IP
|
$2,807.00
|
|
| Hospital Charge Code |
2969375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,375.43 |
| Max. Negotiated Rate |
$2,582.44 |
| Rate for Payer: Aetna Commercial |
$2,526.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.71
|
| Rate for Payer: Cash Price |
$842.10
|
| Rate for Payer: Cigna Commercial |
$2,582.44
|
| Rate for Payer: Health EOS Commercial |
$2,498.23
|
| Rate for Payer: HFN Commercial |
$2,582.44
|
| Rate for Payer: Multiplan Commercial |
$2,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.43
|
| Rate for Payer: Quartz Commercial |
$1,684.20
|
| Rate for Payer: WEA Trust Commercial |
$1,543.85
|
| Rate for Payer: WPS Commercial |
$2,079.14
|
|
|
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 |
$320.46 |
| Max. Negotiated Rate |
$601.68 |
| Rate for Payer: Aetna Commercial |
$588.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.62
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$601.68
|
| Rate for Payer: Health EOS Commercial |
$582.06
|
| Rate for Payer: HFN Commercial |
$601.68
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: NAPHCARE Commercial |
$392.40
|
| Rate for Payer: Preferred Network Access Commercial |
$601.68
|
| Rate for Payer: Quartz Beloit One Network |
$320.46
|
| Rate for Payer: Quartz Commercial |
$392.40
|
| Rate for Payer: WEA Trust Commercial |
$359.70
|
| Rate for Payer: WPS Commercial |
$484.42
|
|
|
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 |
$183.12 |
| Max. Negotiated Rate |
$2,616.00 |
| Rate for Payer: Aetna Commercial |
$588.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.44
|
| Rate for Payer: Aetna Managed Medicare |
$183.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$313.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.62
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$601.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$365.98
|
| Rate for Payer: Health EOS Commercial |
$582.06
|
| Rate for Payer: HFN Commercial |
$601.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$490.50
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: NAPHCARE Commercial |
$392.40
|
| Rate for Payer: Preferred Network Access Commercial |
$601.68
|
| Rate for Payer: Quartz Beloit One Network |
$320.46
|
| Rate for Payer: Quartz Commercial |
$425.10
|
| Rate for Payer: Quartz Medicare Advantage |
$392.40
|
| Rate for Payer: The Alliance Commercial |
$2,616.00
|
| Rate for Payer: WEA Trust Commercial |
$359.70
|
| Rate for Payer: WPS Commercial |
$484.42
|
|
|
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 |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
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 |
$202.72 |
| Max. Negotiated Rate |
$2,896.00 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$202.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.15
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.00
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| Rate for Payer: Quartz Medicare Advantage |
$434.40
|
| Rate for Payer: The Alliance Commercial |
$2,896.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
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 |
$356.23 |
| Max. Negotiated Rate |
$668.84 |
| Rate for Payer: Aetna Commercial |
$654.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$625.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.31
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$668.84
|
| Rate for Payer: Health EOS Commercial |
$647.03
|
| Rate for Payer: HFN Commercial |
$668.84
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: NAPHCARE Commercial |
$436.20
|
| Rate for Payer: Preferred Network Access Commercial |
$668.84
|
| Rate for Payer: Quartz Beloit One Network |
$356.23
|
| Rate for Payer: Quartz Commercial |
$436.20
|
| Rate for Payer: WEA Trust Commercial |
$399.85
|
| Rate for Payer: WPS Commercial |
$538.49
|
|
|
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 |
$203.56 |
| Max. Negotiated Rate |
$2,908.00 |
| Rate for Payer: Aetna Commercial |
$654.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$625.22
|
| Rate for Payer: Aetna Managed Medicare |
$203.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$472.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$363.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.31
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$668.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.83
|
| Rate for Payer: Health EOS Commercial |
$647.03
|
| Rate for Payer: HFN Commercial |
$668.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$545.25
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: NAPHCARE Commercial |
$436.20
|
| Rate for Payer: Preferred Network Access Commercial |
$668.84
|
| Rate for Payer: Quartz Beloit One Network |
$356.23
|
| Rate for Payer: Quartz Commercial |
$472.55
|
| Rate for Payer: Quartz Medicare Advantage |
$436.20
|
| Rate for Payer: The Alliance Commercial |
$2,908.00
|
| Rate for Payer: WEA Trust Commercial |
$399.85
|
| Rate for Payer: WPS Commercial |
$538.49
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC 2 METRIC NON-ABSORBABLE C-20 NEEDLE 6 IN VLOCN0604
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
5599597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
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 |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC 90 PGA-PCL OS-2/P12 REVERSE CUT 12 IN UNDYED VL0CM0024
|
Facility
|
OP
|
$724.00
|
|
| Hospital Charge Code |
6214970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$2,896.00 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$202.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.15
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.00
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| Rate for Payer: Quartz Medicare Advantage |
$434.40
|
| Rate for Payer: The Alliance Commercial |
$2,896.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC 90 PGA-PCL OS-2/P12 REVERSE CUT 12 IN UNDYED VL0CM0024
|
Facility
|
IP
|
$724.00
|
|
| Hospital Charge Code |
6214970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 6 IN VLOCL0804
|
Facility
|
OP
|
$544.00
|
|
| Hospital Charge Code |
5895668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.32 |
| Max. Negotiated Rate |
$2,176.00 |
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.84
|
| Rate for Payer: Aetna Managed Medicare |
$152.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.32
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$500.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.42
|
| Rate for Payer: Health EOS Commercial |
$484.16
|
| Rate for Payer: HFN Commercial |
$500.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: NAPHCARE Commercial |
$326.40
|
| Rate for Payer: Preferred Network Access Commercial |
$500.48
|
| Rate for Payer: Quartz Beloit One Network |
$266.56
|
| Rate for Payer: Quartz Commercial |
$353.60
|
| Rate for Payer: Quartz Medicare Advantage |
$326.40
|
| Rate for Payer: The Alliance Commercial |
$2,176.00
|
| Rate for Payer: WEA Trust Commercial |
$299.20
|
| Rate for Payer: WPS Commercial |
$402.94
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 6 IN VLOCL0804
|
Facility
|
IP
|
$544.00
|
|
| Hospital Charge Code |
5895668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.56 |
| Max. Negotiated Rate |
$500.48 |
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.32
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$500.48
|
| Rate for Payer: Health EOS Commercial |
$484.16
|
| Rate for Payer: HFN Commercial |
$500.48
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: NAPHCARE Commercial |
$326.40
|
| Rate for Payer: Preferred Network Access Commercial |
$500.48
|
| Rate for Payer: Quartz Beloit One Network |
$266.56
|
| Rate for Payer: Quartz Commercial |
$326.40
|
| Rate for Payer: WEA Trust Commercial |
$299.20
|
| Rate for Payer: WPS Commercial |
$402.94
|
|
|
SUTURE CLOSURE DEVICE 3-0 V-LOC ABSORBABLE CV-23 NEEDLE 9 IN VLOCL0844
|
Facility
|
OP
|
$650.00
|
|
| Hospital Charge Code |
5917694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Aetna Managed Medicare |
$182.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$422.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.74
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.50
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$422.50
|
| Rate for Payer: Quartz Medicare Advantage |
$390.00
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
