|
MESH 6 X 6 ULTRAPRO UMM3
|
Facility
|
IP
|
$1,929.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$945.21 |
| Max. Negotiated Rate |
$1,774.68 |
| Rate for Payer: Aetna Commercial |
$1,736.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,658.94
|
| 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: Health EOS Commercial |
$1,716.81
|
| Rate for Payer: HFN Commercial |
$1,774.68
|
| 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 |
$1,157.40
|
| Rate for Payer: WEA Trust Commercial |
$1,060.95
|
| Rate for Payer: WPS Commercial |
$1,428.81
|
|
|
MESH 6 X 8 OVAL PROCEED PCDG1
|
Facility
|
OP
|
$7,171.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,007.88 |
| Max. Negotiated Rate |
$28,684.00 |
| Rate for Payer: Aetna Commercial |
$6,453.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,167.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,007.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,661.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,442.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,800.63
|
| Rate for Payer: Cash Price |
$2,151.30
|
| Rate for Payer: Cigna Commercial |
$6,597.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,012.89
|
| Rate for Payer: Health EOS Commercial |
$6,382.19
|
| Rate for Payer: HFN Commercial |
$6,597.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,378.25
|
| Rate for Payer: Multiplan Commercial |
$5,736.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,302.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,597.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,513.79
|
| Rate for Payer: Quartz Commercial |
$4,661.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,302.60
|
| Rate for Payer: The Alliance Commercial |
$28,684.00
|
| Rate for Payer: WEA Trust Commercial |
$3,944.05
|
| Rate for Payer: WPS Commercial |
$5,311.56
|
|
|
MESH 6 X 8 OVAL PROCEED PCDG1
|
Facility
|
IP
|
$7,171.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,513.79 |
| Max. Negotiated Rate |
$6,597.32 |
| Rate for Payer: Aetna Commercial |
$6,453.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,167.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,800.63
|
| Rate for Payer: Cash Price |
$2,151.30
|
| Rate for Payer: Cigna Commercial |
$6,597.32
|
| Rate for Payer: Health EOS Commercial |
$6,382.19
|
| Rate for Payer: HFN Commercial |
$6,597.32
|
| Rate for Payer: Multiplan Commercial |
$5,736.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,302.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,597.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,513.79
|
| Rate for Payer: Quartz Commercial |
$4,302.60
|
| Rate for Payer: WEA Trust Commercial |
$3,944.05
|
| Rate for Payer: WPS Commercial |
$5,311.56
|
|
|
MESH 6 X 8 PHYSIOMESH PHY1520V
|
Facility
|
IP
|
$6,307.00
|
|
| Hospital Charge Code |
2969372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,090.43 |
| Max. Negotiated Rate |
$5,802.44 |
| Rate for Payer: Aetna Commercial |
$5,676.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,424.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.71
|
| Rate for Payer: Cash Price |
$1,892.10
|
| Rate for Payer: Cigna Commercial |
$5,802.44
|
| Rate for Payer: Health EOS Commercial |
$5,613.23
|
| Rate for Payer: HFN Commercial |
$5,802.44
|
| Rate for Payer: Multiplan Commercial |
$5,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,784.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,802.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,090.43
|
| Rate for Payer: Quartz Commercial |
$3,784.20
|
| Rate for Payer: WEA Trust Commercial |
$3,468.85
|
| Rate for Payer: WPS Commercial |
$4,671.59
|
|
|
MESH 6 X 8 PHYSIOMESH PHY1520V
|
Facility
|
OP
|
$6,307.00
|
|
| Hospital Charge Code |
2969372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.96 |
| Max. Negotiated Rate |
$25,228.00 |
| Rate for Payer: Aetna Commercial |
$5,676.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,424.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,099.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,153.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,027.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.71
|
| Rate for Payer: Cash Price |
$1,892.10
|
| Rate for Payer: Cigna Commercial |
$5,802.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,529.40
|
| Rate for Payer: Health EOS Commercial |
$5,613.23
|
| Rate for Payer: HFN Commercial |
$5,802.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,730.25
|
| Rate for Payer: Multiplan Commercial |
$5,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,784.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,802.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,090.43
|
| Rate for Payer: Quartz Commercial |
$4,099.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,784.20
|
| Rate for Payer: The Alliance Commercial |
$25,228.00
|
| Rate for Payer: WEA Trust Commercial |
$3,468.85
|
| Rate for Payer: WPS Commercial |
$4,671.59
|
|
|
MESH 8 X 10 OVAL PROCEED PCDH1
|
Facility
|
OP
|
$7,732.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.96 |
| Max. Negotiated Rate |
$30,928.00 |
| Rate for Payer: Aetna Commercial |
$6,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,649.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,164.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,025.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,866.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,097.96
|
| Rate for Payer: Cash Price |
$2,319.60
|
| Rate for Payer: Cigna Commercial |
$7,113.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,326.83
|
| Rate for Payer: Health EOS Commercial |
$6,881.48
|
| Rate for Payer: HFN Commercial |
$7,113.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,799.00
|
| Rate for Payer: Multiplan Commercial |
$6,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,113.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,788.68
|
| Rate for Payer: Quartz Commercial |
$5,025.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,639.20
|
| Rate for Payer: The Alliance Commercial |
$30,928.00
|
| Rate for Payer: WEA Trust Commercial |
$4,252.60
|
| Rate for Payer: WPS Commercial |
$5,727.09
|
|
|
MESH 8 X 10 OVAL PROCEED PCDH1
|
Facility
|
IP
|
$7,732.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,788.68 |
| Max. Negotiated Rate |
$7,113.44 |
| Rate for Payer: Aetna Commercial |
$6,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,649.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,097.96
|
| Rate for Payer: Cash Price |
$2,319.60
|
| Rate for Payer: Cigna Commercial |
$7,113.44
|
| Rate for Payer: Health EOS Commercial |
$6,881.48
|
| Rate for Payer: HFN Commercial |
$7,113.44
|
| Rate for Payer: Multiplan Commercial |
$6,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,113.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,788.68
|
| Rate for Payer: Quartz Commercial |
$4,639.20
|
| Rate for Payer: WEA Trust Commercial |
$4,252.60
|
| Rate for Payer: WPS Commercial |
$5,727.09
|
|
|
MESH BARD SOFT 3 X 6CM 0117009
|
Facility
|
IP
|
$946.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.54 |
| Max. Negotiated Rate |
$870.32 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$567.60
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
MESH BARD SOFT 3 X 6CM 0117009
|
Facility
|
OP
|
$946.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Aetna Managed Medicare |
$264.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$473.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$454.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.38
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$709.50
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$614.90
|
| Rate for Payer: Quartz Medicare Advantage |
$567.60
|
| Rate for Payer: The Alliance Commercial |
$3,784.00
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
MESH DUAL BIO 10 x 15 x 1
|
Facility
|
IP
|
$4,759.00
|
|
| Hospital Charge Code |
2967380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.91 |
| Max. Negotiated Rate |
$4,378.28 |
| Rate for Payer: Aetna Commercial |
$4,283.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.27
|
| Rate for Payer: Cash Price |
$1,427.70
|
| Rate for Payer: Cigna Commercial |
$4,378.28
|
| Rate for Payer: Health EOS Commercial |
$4,235.51
|
| Rate for Payer: HFN Commercial |
$4,378.28
|
| Rate for Payer: Multiplan Commercial |
$3,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,855.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.91
|
| Rate for Payer: Quartz Commercial |
$2,855.40
|
| Rate for Payer: WEA Trust Commercial |
$2,617.45
|
| Rate for Payer: WPS Commercial |
$3,524.99
|
|
|
MESH DUAL BIO 10 x 15 x 1
|
Facility
|
OP
|
$4,759.00
|
|
| Hospital Charge Code |
2967380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.52 |
| Max. Negotiated Rate |
$19,036.00 |
| Rate for Payer: Aetna Commercial |
$4,283.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,093.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,284.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.27
|
| Rate for Payer: Cash Price |
$1,427.70
|
| Rate for Payer: Cigna Commercial |
$4,378.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,663.14
|
| Rate for Payer: Health EOS Commercial |
$4,235.51
|
| Rate for Payer: HFN Commercial |
$4,378.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,569.25
|
| Rate for Payer: Multiplan Commercial |
$3,807.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,855.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.91
|
| Rate for Payer: Quartz Commercial |
$3,093.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,855.40
|
| Rate for Payer: The Alliance Commercial |
$19,036.00
|
| Rate for Payer: WEA Trust Commercial |
$2,617.45
|
| Rate for Payer: WPS Commercial |
$3,524.99
|
|
|
MESH LARGE ULTRA PRO PLUG UPPL
|
Facility
|
IP
|
$3,002.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
3072517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.98 |
| Max. Negotiated Rate |
$2,761.84 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,801.20
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
MESH LARGE ULTRA PRO PLUG UPPL
|
Facility
|
OP
|
$3,002.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
3072517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$12,008.00 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Aetna Managed Medicare |
$840.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,951.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,251.50
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,951.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,801.20
|
| Rate for Payer: The Alliance Commercial |
$12,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
MESH MEDIUM ULTRA PRO PLUG UPPM
|
Facility
|
OP
|
$3,002.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$12,008.00 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Aetna Managed Medicare |
$840.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,951.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,251.50
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,951.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,801.20
|
| Rate for Payer: The Alliance Commercial |
$12,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
MESH MEDIUM ULTRA PRO PLUG UPPM
|
Facility
|
IP
|
$3,002.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.98 |
| Max. Negotiated Rate |
$2,761.84 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,801.20
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
MESH PARIETENE DS 15CM X 10CM PPDS1510
|
Facility
|
IP
|
$3,239.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
5384725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,587.11 |
| Max. Negotiated Rate |
$2,979.88 |
| Rate for Payer: Aetna Commercial |
$2,915.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,785.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,716.67
|
| Rate for Payer: Cash Price |
$971.70
|
| Rate for Payer: Cigna Commercial |
$2,979.88
|
| Rate for Payer: Health EOS Commercial |
$2,882.71
|
| Rate for Payer: HFN Commercial |
$2,979.88
|
| Rate for Payer: Multiplan Commercial |
$2,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,979.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,587.11
|
| Rate for Payer: Quartz Commercial |
$1,943.40
|
| Rate for Payer: WEA Trust Commercial |
$1,781.45
|
| Rate for Payer: WPS Commercial |
$2,399.13
|
|
|
MESH PARIETENE DS 15CM X 10CM PPDS1510
|
Facility
|
OP
|
$3,239.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
5384725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.92 |
| Max. Negotiated Rate |
$12,956.00 |
| Rate for Payer: Aetna Commercial |
$2,915.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,785.54
|
| Rate for Payer: Aetna Managed Medicare |
$906.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,105.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,619.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,554.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,716.67
|
| Rate for Payer: Cash Price |
$971.70
|
| Rate for Payer: Cigna Commercial |
$2,979.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,812.54
|
| Rate for Payer: Health EOS Commercial |
$2,882.71
|
| Rate for Payer: HFN Commercial |
$2,979.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,429.25
|
| Rate for Payer: Multiplan Commercial |
$2,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,979.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,587.11
|
| Rate for Payer: Quartz Commercial |
$2,105.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,943.40
|
| Rate for Payer: The Alliance Commercial |
$12,956.00
|
| Rate for Payer: WEA Trust Commercial |
$1,781.45
|
| Rate for Payer: WPS Commercial |
$2,399.13
|
|
|
MESH PARIETEX VENTRAL PATCH ROUND PCO4VP
|
Facility
|
OP
|
$3,681.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
5306781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.68 |
| Max. Negotiated Rate |
$14,724.00 |
| Rate for Payer: Aetna Commercial |
$3,312.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,030.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,392.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,840.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,766.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.93
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cigna Commercial |
$3,386.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,059.89
|
| Rate for Payer: Health EOS Commercial |
$3,276.09
|
| Rate for Payer: HFN Commercial |
$3,386.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,760.75
|
| Rate for Payer: Multiplan Commercial |
$2,944.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,208.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.69
|
| Rate for Payer: Quartz Commercial |
$2,392.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,208.60
|
| Rate for Payer: The Alliance Commercial |
$14,724.00
|
| Rate for Payer: WEA Trust Commercial |
$2,024.55
|
| Rate for Payer: WPS Commercial |
$2,726.52
|
|
|
MESH PARIETEX VENTRAL PATCH ROUND PCO4VP
|
Facility
|
IP
|
$3,681.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
5306781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$3,386.52 |
| Rate for Payer: Aetna Commercial |
$3,312.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.93
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cigna Commercial |
$3,386.52
|
| Rate for Payer: Health EOS Commercial |
$3,276.09
|
| Rate for Payer: HFN Commercial |
$3,386.52
|
| Rate for Payer: Multiplan Commercial |
$2,944.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,208.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.69
|
| Rate for Payer: Quartz Commercial |
$2,208.60
|
| Rate for Payer: WEA Trust Commercial |
$2,024.55
|
| Rate for Payer: WPS Commercial |
$2,726.52
|
|
|
MESH PERFIX PLUG & PATCH MEDIUM 1.3 IN X 1.55 IN 0112760
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.13 |
| Max. Negotiated Rate |
$1,414.04 |
| Rate for Payer: Aetna Commercial |
$1,383.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.61
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cigna Commercial |
$1,414.04
|
| Rate for Payer: Health EOS Commercial |
$1,367.93
|
| Rate for Payer: HFN Commercial |
$1,414.04
|
| Rate for Payer: Multiplan Commercial |
$1,229.60
|
| Rate for Payer: NAPHCARE Commercial |
$922.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,414.04
|
| Rate for Payer: Quartz Beloit One Network |
$753.13
|
| Rate for Payer: Quartz Commercial |
$922.20
|
| Rate for Payer: WEA Trust Commercial |
$845.35
|
| Rate for Payer: WPS Commercial |
$1,138.46
|
|
|
MESH PERFIX PLUG & PATCH MEDIUM 1.3 IN X 1.55 IN 0112760
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.36 |
| Max. Negotiated Rate |
$6,148.00 |
| Rate for Payer: Aetna Commercial |
$1,383.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.61
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cigna Commercial |
$1,414.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.11
|
| Rate for Payer: Health EOS Commercial |
$1,367.93
|
| Rate for Payer: HFN Commercial |
$1,414.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.75
|
| Rate for Payer: Multiplan Commercial |
$1,229.60
|
| Rate for Payer: NAPHCARE Commercial |
$922.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,414.04
|
| Rate for Payer: Quartz Beloit One Network |
$753.13
|
| Rate for Payer: Quartz Commercial |
$999.05
|
| Rate for Payer: Quartz Medicare Advantage |
$922.20
|
| Rate for Payer: The Alliance Commercial |
$6,148.00
|
| Rate for Payer: WEA Trust Commercial |
$845.35
|
| Rate for Payer: WPS Commercial |
$1,138.46
|
|
|
MESH PERFIX PLUG & PATCH SMALL 1 IN X 1.35 IN 0112750
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$888.60
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
MESH PERFIX PLUG & PATCH SMALL 1 IN X 1.35 IN 0112750
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.68 |
| Max. Negotiated Rate |
$5,924.00 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Aetna Managed Medicare |
$414.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.75
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$962.65
|
| Rate for Payer: Quartz Medicare Advantage |
$888.60
|
| Rate for Payer: The Alliance Commercial |
$5,924.00
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
MESH PERFIX PLUG & PATCH X-LG 1.6 IN X 2 IN 0112780
|
Facility
|
OP
|
$2,986.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.08 |
| Max. Negotiated Rate |
$11,944.00 |
| Rate for Payer: Aetna Commercial |
$2,687.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,567.96
|
| Rate for Payer: Aetna Managed Medicare |
$836.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,940.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,493.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,433.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,582.58
|
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cigna Commercial |
$2,747.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,670.97
|
| Rate for Payer: Health EOS Commercial |
$2,657.54
|
| Rate for Payer: HFN Commercial |
$2,747.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,239.50
|
| Rate for Payer: Multiplan Commercial |
$2,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,791.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,747.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,463.14
|
| Rate for Payer: Quartz Commercial |
$1,940.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,791.60
|
| Rate for Payer: The Alliance Commercial |
$11,944.00
|
| Rate for Payer: WEA Trust Commercial |
$1,642.30
|
| Rate for Payer: WPS Commercial |
$2,211.73
|
|
|
MESH PERFIX PLUG & PATCH X-LG 1.6 IN X 2 IN 0112780
|
Facility
|
IP
|
$2,986.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.14 |
| Max. Negotiated Rate |
$2,747.12 |
| Rate for Payer: Aetna Commercial |
$2,687.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,567.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,582.58
|
| Rate for Payer: Cash Price |
$895.80
|
| Rate for Payer: Cigna Commercial |
$2,747.12
|
| Rate for Payer: Health EOS Commercial |
$2,657.54
|
| Rate for Payer: HFN Commercial |
$2,747.12
|
| Rate for Payer: Multiplan Commercial |
$2,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,791.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,747.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,463.14
|
| Rate for Payer: Quartz Commercial |
$1,791.60
|
| Rate for Payer: WEA Trust Commercial |
$1,642.30
|
| Rate for Payer: WPS Commercial |
$2,211.73
|
|
