|
SUTURE 7-0 PROLENE 30 IN 8704H
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2965750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
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 |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 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 |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 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 |
$394.58 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Aetna Managed Medicare |
$394.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.61
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.90
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: NAPHCARE Commercial |
$845.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$915.98
|
| Rate for Payer: Quartz Medicare Advantage |
$845.52
|
| Rate for Payer: The Alliance Commercial |
$704.60
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
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 |
$690.51 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$845.52
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
SUTURE 7-0 PROLENE M8702
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2965751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
SUTURE 7-0 PROLENE M8702
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2965751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
SUTURE 7-0 VICRYL J566G
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
6171650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SUTURE 7-0 VICRYL J566G
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
6171650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
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 |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 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 |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 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 |
$33.49 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
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 |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
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 |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 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 |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 8-0 VICRYL J548G
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
6171651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
SUTURE 8-0 VICRYL J548G
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
6171651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Aetna Managed Medicare |
$81.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.96
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$189.28
|
| Rate for Payer: Quartz Medicare Advantage |
$174.72
|
| Rate for Payer: The Alliance Commercial |
$145.60
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
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 |
$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 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 |
$20.97 |
| 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 9-0 ETHILON BV130-4 5 IN BLACK 2813G
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2965756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE 9-0 ETHILON BV130-4 5 IN BLACK 2813G
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2965756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW BIOCOMPOSITE AR-1941BC
|
Facility
|
OP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.61 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,201.71
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,950.74
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,360.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,557.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,360.59
|
| Rate for Payer: The Alliance Commercial |
$1,967.16
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW BIOCOMPOSITE AR-1941BC
|
Facility
|
IP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.82 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,360.59
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW PEEK AR-1941PSV
|
Facility
|
OP
|
$4,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.79 |
| Max. Negotiated Rate |
$4,198.44 |
| Rate for Payer: Aetna Commercial |
$4,107.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,924.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,277.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,966.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,281.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,190.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,418.67
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,198.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,553.82
|
| Rate for Payer: Health EOS Commercial |
$4,061.53
|
| Rate for Payer: HFN Commercial |
$4,198.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,422.64
|
| Rate for Payer: Multiplan Commercial |
$3,650.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,738.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,236.12
|
| Rate for Payer: Quartz Commercial |
$2,966.29
|
| Rate for Payer: Quartz Medicare Advantage |
$2,738.11
|
| Rate for Payer: The Alliance Commercial |
$2,281.76
|
| Rate for Payer: WEA Trust Commercial |
$2,509.94
|
| Rate for Payer: WPS Commercial |
$3,380.08
|
|
|
SUTURE ANCHOR 3.9MM KNOTLESS CORKSCREW PEEK AR-1941PSV
|
Facility
|
IP
|
$4,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,236.12 |
| Max. Negotiated Rate |
$4,198.44 |
| Rate for Payer: Aetna Commercial |
$4,107.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,924.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,418.67
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,198.44
|
| Rate for Payer: Health EOS Commercial |
$4,061.53
|
| Rate for Payer: HFN Commercial |
$4,198.44
|
| Rate for Payer: Multiplan Commercial |
$3,650.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,236.12
|
| Rate for Payer: Quartz Commercial |
$2,738.11
|
| Rate for Payer: WEA Trust Commercial |
$2,509.94
|
| Rate for Payer: WPS Commercial |
$3,380.08
|
|
