|
MEROCEL AMBRUS EAR PACKING 400354
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
3259481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
MEROCEL AMBRUS EAR PACKING 400354
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
3259481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
MESH 12 X 12 PROCEED RECTANGLE PCDL1
|
Facility
|
OP
|
$11,413.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,195.64 |
| Max. Negotiated Rate |
$45,652.00 |
| Rate for Payer: Aetna Commercial |
$10,271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,815.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,195.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,418.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,706.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,478.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,048.89
|
| Rate for Payer: Cash Price |
$3,423.90
|
| Rate for Payer: Cigna Commercial |
$10,499.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,386.71
|
| Rate for Payer: Health EOS Commercial |
$10,157.57
|
| Rate for Payer: HFN Commercial |
$10,499.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,559.75
|
| Rate for Payer: Multiplan Commercial |
$9,130.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,847.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,499.96
|
| Rate for Payer: Quartz Beloit One Network |
$5,592.37
|
| Rate for Payer: Quartz Commercial |
$7,418.45
|
| Rate for Payer: Quartz Medicare Advantage |
$6,847.80
|
| Rate for Payer: The Alliance Commercial |
$45,652.00
|
| Rate for Payer: WEA Trust Commercial |
$6,277.15
|
| Rate for Payer: WPS Commercial |
$8,453.61
|
|
|
MESH 12 X 12 PROCEED RECTANGLE PCDL1
|
Facility
|
IP
|
$11,413.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,592.37 |
| Max. Negotiated Rate |
$10,499.96 |
| Rate for Payer: Aetna Commercial |
$10,271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,815.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,048.89
|
| Rate for Payer: Cash Price |
$3,423.90
|
| Rate for Payer: Cigna Commercial |
$10,499.96
|
| Rate for Payer: Health EOS Commercial |
$10,157.57
|
| Rate for Payer: HFN Commercial |
$10,499.96
|
| Rate for Payer: Multiplan Commercial |
$9,130.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,847.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,499.96
|
| Rate for Payer: Quartz Beloit One Network |
$5,592.37
|
| Rate for Payer: Quartz Commercial |
$6,847.80
|
| Rate for Payer: WEA Trust Commercial |
$6,277.15
|
| Rate for Payer: WPS Commercial |
$8,453.61
|
|
|
MESH 3D MAX LIGHT RT LARGE 0117321
|
Facility
|
OP
|
$2,918.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.04 |
| Max. Negotiated Rate |
$11,672.00 |
| Rate for Payer: Aetna Commercial |
$2,626.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,509.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,896.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,400.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,546.54
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,684.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,632.91
|
| Rate for Payer: Health EOS Commercial |
$2,597.02
|
| Rate for Payer: HFN Commercial |
$2,684.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,188.50
|
| Rate for Payer: Multiplan Commercial |
$2,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,750.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,684.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,429.82
|
| Rate for Payer: Quartz Commercial |
$1,896.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,750.80
|
| Rate for Payer: The Alliance Commercial |
$11,672.00
|
| Rate for Payer: WEA Trust Commercial |
$1,604.90
|
| Rate for Payer: WPS Commercial |
$2,161.36
|
|
|
MESH 3D MAX LIGHT RT LARGE 0117321
|
Facility
|
IP
|
$2,918.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,429.82 |
| Max. Negotiated Rate |
$2,684.56 |
| Rate for Payer: Aetna Commercial |
$2,626.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,509.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,546.54
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,684.56
|
| Rate for Payer: Health EOS Commercial |
$2,597.02
|
| Rate for Payer: HFN Commercial |
$2,684.56
|
| Rate for Payer: Multiplan Commercial |
$2,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,750.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,684.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,429.82
|
| Rate for Payer: Quartz Commercial |
$1,750.80
|
| Rate for Payer: WEA Trust Commercial |
$1,604.90
|
| Rate for Payer: WPS Commercial |
$2,161.36
|
|
|
MESH 3D MAX LT EX-LARGE 0115322
|
Facility
|
IP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.30 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,542.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
MESH 3D MAX LT EX-LARGE 0115322
|
Facility
|
OP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.60 |
| Max. Negotiated Rate |
$10,280.00 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Aetna Managed Medicare |
$719.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,670.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,285.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,438.17
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,927.50
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,670.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,542.00
|
| Rate for Payer: The Alliance Commercial |
$10,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
MESH 3D MAX LT LARGE 0115311
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
MESH 3D MAX LT LARGE 0115311
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
MESH 3D MAX LT MED 0115310
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.32 |
| Max. Negotiated Rate |
$11,476.00 |
| Rate for Payer: Aetna Commercial |
$2,582.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,467.34
|
| Rate for Payer: Aetna Managed Medicare |
$803.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.57
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,639.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,605.49
|
| Rate for Payer: Health EOS Commercial |
$2,553.41
|
| Rate for Payer: HFN Commercial |
$2,639.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,151.75
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,721.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.81
|
| Rate for Payer: Quartz Commercial |
$1,864.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,721.40
|
| Rate for Payer: The Alliance Commercial |
$11,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.95
|
| Rate for Payer: WPS Commercial |
$2,125.07
|
|
|
MESH 3D MAX LT MED 0115310
|
Facility
|
IP
|
$2,869.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.81 |
| Max. Negotiated Rate |
$2,639.48 |
| Rate for Payer: Aetna Commercial |
$2,582.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,467.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.57
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,639.48
|
| Rate for Payer: Health EOS Commercial |
$2,553.41
|
| Rate for Payer: HFN Commercial |
$2,639.48
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,721.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.81
|
| Rate for Payer: Quartz Commercial |
$1,721.40
|
| Rate for Payer: WEA Trust Commercial |
$1,577.95
|
| Rate for Payer: WPS Commercial |
$2,125.07
|
|
|
MESH 3D MAX RT EX-LARGE 0115312
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.28 |
| Max. Negotiated Rate |
$9,904.00 |
| Rate for Payer: Aetna Commercial |
$2,228.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,129.36
|
| Rate for Payer: Aetna Managed Medicare |
$693.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,238.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,312.28
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,277.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,385.57
|
| Rate for Payer: Health EOS Commercial |
$2,203.64
|
| Rate for Payer: HFN Commercial |
$2,277.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,857.00
|
| Rate for Payer: Multiplan Commercial |
$1,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,213.24
|
| Rate for Payer: Quartz Commercial |
$1,609.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,485.60
|
| Rate for Payer: The Alliance Commercial |
$9,904.00
|
| Rate for Payer: WEA Trust Commercial |
$1,361.80
|
| Rate for Payer: WPS Commercial |
$1,833.97
|
|
|
MESH 3D MAX RT EX-LARGE 0115312
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4858921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.24 |
| Max. Negotiated Rate |
$2,277.92 |
| Rate for Payer: Aetna Commercial |
$2,228.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,129.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,312.28
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,277.92
|
| Rate for Payer: Health EOS Commercial |
$2,203.64
|
| Rate for Payer: HFN Commercial |
$2,277.92
|
| Rate for Payer: Multiplan Commercial |
$1,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,213.24
|
| Rate for Payer: Quartz Commercial |
$1,485.60
|
| Rate for Payer: WEA Trust Commercial |
$1,361.80
|
| Rate for Payer: WPS Commercial |
$1,833.97
|
|
|
MESH 3D MAX RT LARGE 0115321
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
MESH 3D MAX RT LARGE 0115321
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
MESH 3D MAX RT MED 0115320
|
Facility
|
IP
|
$2,869.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.81 |
| Max. Negotiated Rate |
$2,639.48 |
| Rate for Payer: Aetna Commercial |
$2,582.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,467.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.57
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,639.48
|
| Rate for Payer: Health EOS Commercial |
$2,553.41
|
| Rate for Payer: HFN Commercial |
$2,639.48
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,721.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.81
|
| Rate for Payer: Quartz Commercial |
$1,721.40
|
| Rate for Payer: WEA Trust Commercial |
$1,577.95
|
| Rate for Payer: WPS Commercial |
$2,125.07
|
|
|
MESH 3D MAX RT MED 0115320
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.32 |
| Max. Negotiated Rate |
$11,476.00 |
| Rate for Payer: Aetna Commercial |
$2,582.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,467.34
|
| Rate for Payer: Aetna Managed Medicare |
$803.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.57
|
| Rate for Payer: Cash Price |
$860.70
|
| Rate for Payer: Cigna Commercial |
$2,639.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,605.49
|
| Rate for Payer: Health EOS Commercial |
$2,553.41
|
| Rate for Payer: HFN Commercial |
$2,639.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,151.75
|
| Rate for Payer: Multiplan Commercial |
$2,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,721.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.81
|
| Rate for Payer: Quartz Commercial |
$1,864.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,721.40
|
| Rate for Payer: The Alliance Commercial |
$11,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.95
|
| Rate for Payer: WPS Commercial |
$2,125.07
|
|
|
MESH 3 X 6 ULTRAPRO UMR3
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.32 |
| Max. Negotiated Rate |
$6,076.00 |
| Rate for Payer: Aetna Commercial |
$1,367.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Aetna Managed Medicare |
$425.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$987.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$759.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.07
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,397.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.03
|
| Rate for Payer: Health EOS Commercial |
$1,351.91
|
| Rate for Payer: HFN Commercial |
$1,397.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,139.25
|
| Rate for Payer: Multiplan Commercial |
$1,215.20
|
| Rate for Payer: NAPHCARE Commercial |
$911.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.48
|
| Rate for Payer: Quartz Beloit One Network |
$744.31
|
| Rate for Payer: Quartz Commercial |
$987.35
|
| Rate for Payer: Quartz Medicare Advantage |
$911.40
|
| Rate for Payer: The Alliance Commercial |
$6,076.00
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
MESH 3 X 6 ULTRAPRO UMR3
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.31 |
| Max. Negotiated Rate |
$1,397.48 |
| Rate for Payer: Aetna Commercial |
$1,367.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.07
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,397.48
|
| Rate for Payer: Health EOS Commercial |
$1,351.91
|
| Rate for Payer: HFN Commercial |
$1,397.48
|
| Rate for Payer: Multiplan Commercial |
$1,215.20
|
| Rate for Payer: NAPHCARE Commercial |
$911.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.48
|
| Rate for Payer: Quartz Beloit One Network |
$744.31
|
| Rate for Payer: Quartz Commercial |
$911.40
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
MESH 4 X 6 OVAL PROCEED PCDN1
|
Facility
|
IP
|
$3,960.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,940.40 |
| Max. Negotiated Rate |
$3,643.20 |
| Rate for Payer: Aetna Commercial |
$3,564.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.80
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna Commercial |
$3,643.20
|
| Rate for Payer: Health EOS Commercial |
$3,524.40
|
| Rate for Payer: HFN Commercial |
$3,643.20
|
| Rate for Payer: Multiplan Commercial |
$3,168.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.40
|
| Rate for Payer: Quartz Commercial |
$2,376.00
|
| Rate for Payer: WEA Trust Commercial |
$2,178.00
|
| Rate for Payer: WPS Commercial |
$2,933.17
|
|
|
MESH 4 X 6 OVAL PROCEED PCDN1
|
Facility
|
OP
|
$3,960.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.80 |
| Max. Negotiated Rate |
$15,840.00 |
| Rate for Payer: Aetna Commercial |
$3,564.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,574.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,980.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,900.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.80
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna Commercial |
$3,643.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,216.02
|
| Rate for Payer: Health EOS Commercial |
$3,524.40
|
| Rate for Payer: HFN Commercial |
$3,643.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,970.00
|
| Rate for Payer: Multiplan Commercial |
$3,168.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.40
|
| Rate for Payer: Quartz Commercial |
$2,574.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,376.00
|
| Rate for Payer: The Alliance Commercial |
$15,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,178.00
|
| Rate for Payer: WPS Commercial |
$2,933.17
|
|
|
MESH 4 X 6 PHYSIOMESH PHY1015V
|
Facility
|
OP
|
$4,630.00
|
|
| Hospital Charge Code |
2969371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,296.40 |
| Max. Negotiated Rate |
$18,520.00 |
| Rate for Payer: Aetna Commercial |
$4,167.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,981.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,296.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,009.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,222.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,453.90
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cigna Commercial |
$4,259.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,590.95
|
| Rate for Payer: Health EOS Commercial |
$4,120.70
|
| Rate for Payer: HFN Commercial |
$4,259.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,472.50
|
| Rate for Payer: Multiplan Commercial |
$3,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,778.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,259.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,268.70
|
| Rate for Payer: Quartz Commercial |
$3,009.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,778.00
|
| Rate for Payer: The Alliance Commercial |
$18,520.00
|
| Rate for Payer: WEA Trust Commercial |
$2,546.50
|
| Rate for Payer: WPS Commercial |
$3,429.44
|
|
|
MESH 4 X 6 PHYSIOMESH PHY1015V
|
Facility
|
IP
|
$4,630.00
|
|
| Hospital Charge Code |
2969371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.70 |
| Max. Negotiated Rate |
$4,259.60 |
| Rate for Payer: Aetna Commercial |
$4,167.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,453.90
|
| Rate for Payer: Cash Price |
$1,389.00
|
| Rate for Payer: Cigna Commercial |
$4,259.60
|
| Rate for Payer: Health EOS Commercial |
$4,120.70
|
| Rate for Payer: HFN Commercial |
$4,259.60
|
| Rate for Payer: Multiplan Commercial |
$3,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,778.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,259.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,268.70
|
| Rate for Payer: Quartz Commercial |
$2,778.00
|
| Rate for Payer: WEA Trust Commercial |
$2,546.50
|
| Rate for Payer: WPS Commercial |
$3,429.44
|
|
|
MESH 6 X 6 ULTRAPRO UMM3
|
Facility
|
OP
|
$1,929.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.12 |
| Max. Negotiated Rate |
$7,716.00 |
| Rate for Payer: Aetna Commercial |
$1,736.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,658.94
|
| Rate for Payer: Aetna Managed Medicare |
$540.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,253.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$964.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,022.37
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cigna Commercial |
$1,774.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,079.47
|
| Rate for Payer: Health EOS Commercial |
$1,716.81
|
| Rate for Payer: HFN Commercial |
$1,774.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,446.75
|
| Rate for Payer: Multiplan Commercial |
$1,543.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,157.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,774.68
|
| Rate for Payer: Quartz Beloit One Network |
$945.21
|
| Rate for Payer: Quartz Commercial |
$1,253.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,157.40
|
| Rate for Payer: The Alliance Commercial |
$7,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,060.95
|
| Rate for Payer: WPS Commercial |
$1,428.81
|
|
