|
SUTURE 6-0 CHROMIC GUT PS-6 REVERSE CUT 18 IN 1816G
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2965730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 ETHILON C-2 REVERSE CUTTING 18 IN BLACK 667G
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2974530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 ETHILON C-2 REVERSE CUTTING 18 IN BLACK 667G
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2974530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 ETHILON P-1 REVERSE CUTTING 18 IN CLEAR 689G
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2965734
|
|
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 6-0 ETHILON P-1 REVERSE CUTTING 18 IN CLEAR 689G
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2965734
|
|
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 6-0 ETHILON P-3 PRECISION POINT-REVERSE CUTTING 18 IN BLACK 1698G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2965732
|
|
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 6-0 ETHILON P-3 PRECISION POINT-REVERSE CUTTING 18 IN BLACK 1698G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2965732
|
|
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 6-0 ETHILON PC-1 COSMETIC-CONVENTIONAL CUTTING 18 IN BLACK 1856G
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2965733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 ETHILON PC-1 COSMETIC-CONVENTIONAL CUTTING 18 IN BLACK 1856G
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2965733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 PDS CLEAR 18 IN PC-1 COSMETIC-CONVENTIONAL CUTTING Z833G
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
5831817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$72.80
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
SUTURE 6-0 PDS CLEAR 18 IN PC-1 COSMETIC-CONVENTIONAL CUTTING Z833G
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
5831817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
SUTURE 6-0 PROLENE 18 IN P-3 REVERSE CUTTING 8695G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2975020
|
|
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 6-0 PROLENE 18 IN P-3 REVERSE CUTTING 8695G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2975020
|
|
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 6-0 PROLENE 8636G
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2965736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 6-0 PROLENE 8636G
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2965736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 6-0 PROLENE 8806H
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2965738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 6-0 PROLENE 8806H
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2965738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 6-0 PROLENE BV-1 TAPER MS/4 X 18 IN DOUBLE ARM BLUE M8806
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2965741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 PROLENE BV-1 TAPER MS/4 X 18 IN DOUBLE ARM BLUE M8806
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2965741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
SUTURE 6-0 PROLENE C-1 TAPER MS/4 X 18 IN DOUBLE ARM BLUE M8718
|
Facility
|
OP
|
$607.00
|
|
| Hospital Charge Code |
5384908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.76 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: Aetna Commercial |
$568.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Aetna Managed Medicare |
$176.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$410.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$303.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.58
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$580.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.27
|
| Rate for Payer: Health EOS Commercial |
$561.84
|
| Rate for Payer: HFN Commercial |
$580.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$473.46
|
| Rate for Payer: Multiplan Commercial |
$505.02
|
| Rate for Payer: NAPHCARE Commercial |
$378.77
|
| Rate for Payer: Preferred Network Access Commercial |
$580.78
|
| Rate for Payer: Quartz Beloit One Network |
$309.33
|
| Rate for Payer: Quartz Commercial |
$410.33
|
| Rate for Payer: Quartz Medicare Advantage |
$378.77
|
| Rate for Payer: The Alliance Commercial |
$315.64
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
SUTURE 6-0 PROLENE C-1 TAPER MS/4 X 18 IN DOUBLE ARM BLUE M8718
|
Facility
|
IP
|
$607.00
|
|
| Hospital Charge Code |
5384908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.33 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: Aetna Commercial |
$568.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.58
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$580.78
|
| Rate for Payer: Health EOS Commercial |
$561.84
|
| Rate for Payer: HFN Commercial |
$580.78
|
| Rate for Payer: Multiplan Commercial |
$505.02
|
| Rate for Payer: Preferred Network Access Commercial |
$580.78
|
| Rate for Payer: Quartz Beloit One Network |
$309.33
|
| Rate for Payer: Quartz Commercial |
$378.77
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
SUTURE 6-0 PROLENE C-1 TAPERPOINT 18 IN DOUBLE-ARM BLUE 8718H
|
Facility
|
IP
|
$202.00
|
|
| Hospital Charge Code |
5384907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.94 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$126.05
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
SUTURE 6-0 PROLENE C-1 TAPERPOINT 18 IN DOUBLE-ARM BLUE 8718H
|
Facility
|
OP
|
$202.00
|
|
| Hospital Charge Code |
5384907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Aetna Managed Medicare |
$58.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.56
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.56
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$126.05
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$126.05
|
| Rate for Payer: The Alliance Commercial |
$105.04
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
SUTURE 6-0 PROLENE C-1 TAPERPOINT DOUBLE ARM 30 8706"
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2965737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE 6-0 PROLENE C-1 TAPERPOINT DOUBLE ARM 30 8706"
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2965737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
