|
MESH PHASIX ST 8 X 10 WITH ECHO 2.0 (20CM X 25CM) 1212025
|
Facility
|
IP
|
$42,950.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
5563380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,045.50 |
| Max. Negotiated Rate |
$39,514.00 |
| Rate for Payer: Aetna Commercial |
$38,655.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,937.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,763.50
|
| Rate for Payer: Cash Price |
$12,885.00
|
| Rate for Payer: Cigna Commercial |
$39,514.00
|
| Rate for Payer: Health EOS Commercial |
$38,225.50
|
| Rate for Payer: HFN Commercial |
$39,514.00
|
| Rate for Payer: Multiplan Commercial |
$34,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$25,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$39,514.00
|
| Rate for Payer: Quartz Beloit One Network |
$21,045.50
|
| Rate for Payer: Quartz Commercial |
$25,770.00
|
| Rate for Payer: WEA Trust Commercial |
$23,622.50
|
| Rate for Payer: WPS Commercial |
$31,813.06
|
|
|
MESH PROCEED VENTRAL MED CIRCLE PVPM
|
Facility
|
OP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,247.12 |
| Max. Negotiated Rate |
$17,816.00 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,247.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,895.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,227.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.46
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,340.50
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,895.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,672.40
|
| Rate for Payer: The Alliance Commercial |
$17,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
MESH PROCEED VENTRAL MED CIRCLE PVPM
|
Facility
|
IP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.46 |
| Max. Negotiated Rate |
$4,097.68 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,672.40
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
MESH PROCEED VENTRAL SM CIRCLE PVPS
|
Facility
|
OP
|
$3,724.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.72 |
| Max. Negotiated Rate |
$14,896.00 |
| Rate for Payer: Aetna Commercial |
$3,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,042.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,420.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,862.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,787.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.72
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,426.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,083.95
|
| Rate for Payer: Health EOS Commercial |
$3,314.36
|
| Rate for Payer: HFN Commercial |
$3,426.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,793.00
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.76
|
| Rate for Payer: Quartz Commercial |
$2,420.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,234.40
|
| Rate for Payer: The Alliance Commercial |
$14,896.00
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
MESH PROCEED VENTRAL SM CIRCLE PVPS
|
Facility
|
IP
|
$3,724.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.76 |
| Max. Negotiated Rate |
$3,426.08 |
| Rate for Payer: Aetna Commercial |
$3,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.72
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,426.08
|
| Rate for Payer: Health EOS Commercial |
$3,314.36
|
| Rate for Payer: HFN Commercial |
$3,426.08
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.76
|
| Rate for Payer: Quartz Commercial |
$2,234.40
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
MESH PROGRIP 15 X 10CM LPG1510
|
Facility
|
OP
|
$3,424.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4493783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.72 |
| Max. Negotiated Rate |
$13,696.00 |
| Rate for Payer: Aetna Commercial |
$3,081.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,944.64
|
| Rate for Payer: Aetna Managed Medicare |
$958.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,225.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,712.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,643.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,814.72
|
| Rate for Payer: Cash Price |
$1,027.20
|
| Rate for Payer: Cigna Commercial |
$3,150.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,916.07
|
| Rate for Payer: Health EOS Commercial |
$3,047.36
|
| Rate for Payer: HFN Commercial |
$3,150.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,568.00
|
| Rate for Payer: Multiplan Commercial |
$2,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,054.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,150.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,677.76
|
| Rate for Payer: Quartz Commercial |
$2,225.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,054.40
|
| Rate for Payer: The Alliance Commercial |
$13,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,883.20
|
| Rate for Payer: WPS Commercial |
$2,536.16
|
|
|
MESH PROGRIP 15 X 10CM LPG1510
|
Facility
|
IP
|
$3,424.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4493783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.76 |
| Max. Negotiated Rate |
$3,150.08 |
| Rate for Payer: Aetna Commercial |
$3,081.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,814.72
|
| Rate for Payer: Cash Price |
$1,027.20
|
| Rate for Payer: Cigna Commercial |
$3,150.08
|
| Rate for Payer: Health EOS Commercial |
$3,047.36
|
| Rate for Payer: HFN Commercial |
$3,150.08
|
| Rate for Payer: Multiplan Commercial |
$2,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,054.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,150.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,677.76
|
| Rate for Payer: Quartz Commercial |
$2,054.40
|
| Rate for Payer: WEA Trust Commercial |
$1,883.20
|
| Rate for Payer: WPS Commercial |
$2,536.16
|
|
|
MESH PROGRIP 16 X 12CM LPG1612
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
6179165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$18,500.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,006.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,312.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,588.15
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,468.75
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$3,006.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.00
|
| Rate for Payer: The Alliance Commercial |
$18,500.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
MESH PROGRIP 16 X 12CM LPG1612
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
6179165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.25 |
| Max. Negotiated Rate |
$4,255.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$2,775.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
MESH PROGRIP POLYESTER MESH 20CM X 15CM TEM2015G
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
6179094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$2,250.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,325.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$2,300.00
|
| Rate for Payer: Health EOS Commercial |
$2,225.00
|
| Rate for Payer: HFN Commercial |
$2,300.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,500.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,300.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.00
|
| Rate for Payer: Quartz Commercial |
$1,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,375.00
|
| Rate for Payer: WPS Commercial |
$1,851.75
|
|
|
MESH PROGRIP POLYESTER MESH 20CM X 15CM TEM2015G
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
6179094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial |
$2,250.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,150.00
|
| Rate for Payer: Aetna Managed Medicare |
$700.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,625.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,250.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,325.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$2,300.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,399.00
|
| Rate for Payer: Health EOS Commercial |
$2,225.00
|
| Rate for Payer: HFN Commercial |
$2,300.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,875.00
|
| Rate for Payer: Multiplan Commercial |
$2,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,500.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,300.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.00
|
| Rate for Payer: Quartz Commercial |
$1,625.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,500.00
|
| Rate for Payer: The Alliance Commercial |
$10,000.00
|
| Rate for Payer: WEA Trust Commercial |
$1,375.00
|
| Rate for Payer: WPS Commercial |
$1,851.75
|
|
|
MESH SMALL ULTRA PRO PLUG UPPS
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.40 |
| Max. Negotiated Rate |
$8,620.00 |
| Rate for Payer: Aetna Commercial |
$1,939.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,853.30
|
| Rate for Payer: Aetna Managed Medicare |
$603.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,400.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,077.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,034.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.15
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,982.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,205.94
|
| Rate for Payer: Health EOS Commercial |
$1,917.95
|
| Rate for Payer: HFN Commercial |
$1,982.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,616.25
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,293.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,982.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.95
|
| Rate for Payer: Quartz Commercial |
$1,400.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,293.00
|
| Rate for Payer: The Alliance Commercial |
$8,620.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
MESH SMALL ULTRA PRO PLUG UPPS
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.95 |
| Max. Negotiated Rate |
$1,982.60 |
| Rate for Payer: Aetna Commercial |
$1,939.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,853.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.15
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,982.60
|
| Rate for Payer: Health EOS Commercial |
$1,917.95
|
| Rate for Payer: HFN Commercial |
$1,982.60
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,293.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,982.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.95
|
| Rate for Payer: Quartz Commercial |
$1,293.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
MESH ULTRAPRO LARGE UHSL
|
Facility
|
IP
|
$3,639.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,783.11 |
| Max. Negotiated Rate |
$3,347.88 |
| Rate for Payer: Aetna Commercial |
$3,275.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,129.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,928.67
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna Commercial |
$3,347.88
|
| Rate for Payer: Health EOS Commercial |
$3,238.71
|
| Rate for Payer: HFN Commercial |
$3,347.88
|
| Rate for Payer: Multiplan Commercial |
$2,911.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,183.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,347.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,783.11
|
| Rate for Payer: Quartz Commercial |
$2,183.40
|
| Rate for Payer: WEA Trust Commercial |
$2,001.45
|
| Rate for Payer: WPS Commercial |
$2,695.41
|
|
|
MESH ULTRAPRO LARGE UHSL
|
Facility
|
OP
|
$3,639.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
2965548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.92 |
| Max. Negotiated Rate |
$14,556.00 |
| Rate for Payer: Aetna Commercial |
$3,275.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,129.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,018.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,365.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,819.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,746.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,928.67
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna Commercial |
$3,347.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,036.38
|
| Rate for Payer: Health EOS Commercial |
$3,238.71
|
| Rate for Payer: HFN Commercial |
$3,347.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.25
|
| Rate for Payer: Multiplan Commercial |
$2,911.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,183.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,347.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,783.11
|
| Rate for Payer: Quartz Commercial |
$2,365.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,183.40
|
| Rate for Payer: The Alliance Commercial |
$14,556.00
|
| Rate for Payer: WEA Trust Commercial |
$2,001.45
|
| Rate for Payer: WPS Commercial |
$2,695.41
|
|
|
MESH VENTRALEX ST HERNIA PATCH 4.3 CM/1.7 IN SMALL 5950007
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,793.00 |
| Max. Negotiated Rate |
$5,244.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,902.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,021.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$5,244.00
|
| Rate for Payer: Health EOS Commercial |
$5,073.00
|
| Rate for Payer: HFN Commercial |
$5,244.00
|
| Rate for Payer: Multiplan Commercial |
$4,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,244.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,793.00
|
| Rate for Payer: Quartz Commercial |
$3,420.00
|
| Rate for Payer: WEA Trust Commercial |
$3,135.00
|
| Rate for Payer: WPS Commercial |
$4,221.99
|
|
|
MESH VENTRALEX ST HERNIA PATCH 4.3 CM/1.7 IN SMALL 5950007
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4594846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.00 |
| Max. Negotiated Rate |
$22,800.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,902.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,596.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,705.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,850.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,736.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,021.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna Commercial |
$5,244.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,189.72
|
| Rate for Payer: Health EOS Commercial |
$5,073.00
|
| Rate for Payer: HFN Commercial |
$5,244.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,275.00
|
| Rate for Payer: Multiplan Commercial |
$4,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,244.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,793.00
|
| Rate for Payer: Quartz Commercial |
$3,705.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,420.00
|
| Rate for Payer: The Alliance Commercial |
$22,800.00
|
| Rate for Payer: WEA Trust Commercial |
$3,135.00
|
| Rate for Payer: WPS Commercial |
$4,221.99
|
|
|
MESH VENTRALEX ST HERNIA PATCH 6.4 CM/2.5 IN MED 5950008
|
Facility
|
IP
|
$5,130.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,513.70 |
| Max. Negotiated Rate |
$4,719.60 |
| Rate for Payer: Aetna Commercial |
$4,617.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,411.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,718.90
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna Commercial |
$4,719.60
|
| Rate for Payer: Health EOS Commercial |
$4,565.70
|
| Rate for Payer: HFN Commercial |
$4,719.60
|
| Rate for Payer: Multiplan Commercial |
$4,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,078.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,719.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,513.70
|
| Rate for Payer: Quartz Commercial |
$3,078.00
|
| Rate for Payer: WEA Trust Commercial |
$2,821.50
|
| Rate for Payer: WPS Commercial |
$3,799.79
|
|
|
MESH VENTRALEX ST HERNIA PATCH 6.4 CM/2.5 IN MED 5950008
|
Facility
|
OP
|
$5,130.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$20,520.00 |
| Rate for Payer: Aetna Commercial |
$4,617.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,411.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,436.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,334.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,565.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,718.90
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cigna Commercial |
$4,719.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,870.75
|
| Rate for Payer: Health EOS Commercial |
$4,565.70
|
| Rate for Payer: HFN Commercial |
$4,719.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,847.50
|
| Rate for Payer: Multiplan Commercial |
$4,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,078.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,719.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,513.70
|
| Rate for Payer: Quartz Commercial |
$3,334.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,078.00
|
| Rate for Payer: The Alliance Commercial |
$20,520.00
|
| Rate for Payer: WEA Trust Commercial |
$2,821.50
|
| Rate for Payer: WPS Commercial |
$3,799.79
|
|
|
MESH VENTRALEX ST LARGE 5950009
|
Facility
|
OP
|
$6,764.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,893.92 |
| Max. Negotiated Rate |
$27,056.00 |
| Rate for Payer: Aetna Commercial |
$6,087.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,817.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,893.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,396.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,382.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,584.92
|
| Rate for Payer: Cash Price |
$2,029.20
|
| Rate for Payer: Cigna Commercial |
$6,222.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,785.13
|
| Rate for Payer: Health EOS Commercial |
$6,019.96
|
| Rate for Payer: HFN Commercial |
$6,222.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,073.00
|
| Rate for Payer: Multiplan Commercial |
$5,411.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,058.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,222.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,314.36
|
| Rate for Payer: Quartz Commercial |
$4,396.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,058.40
|
| Rate for Payer: The Alliance Commercial |
$27,056.00
|
| Rate for Payer: WEA Trust Commercial |
$3,720.20
|
| Rate for Payer: WPS Commercial |
$5,010.09
|
|
|
MESH VENTRALEX ST LARGE 5950009
|
Facility
|
IP
|
$6,764.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,314.36 |
| Max. Negotiated Rate |
$6,222.88 |
| Rate for Payer: Aetna Commercial |
$6,087.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,817.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,584.92
|
| Rate for Payer: Cash Price |
$2,029.20
|
| Rate for Payer: Cigna Commercial |
$6,222.88
|
| Rate for Payer: Health EOS Commercial |
$6,019.96
|
| Rate for Payer: HFN Commercial |
$6,222.88
|
| Rate for Payer: Multiplan Commercial |
$5,411.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,058.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,222.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,314.36
|
| Rate for Payer: Quartz Commercial |
$4,058.40
|
| Rate for Payer: WEA Trust Commercial |
$3,720.20
|
| Rate for Payer: WPS Commercial |
$5,010.09
|
|
|
MESH VENTRALIGHT ECHO (25X30CM) 5955113
|
Facility
|
IP
|
$16,435.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,053.15 |
| Max. Negotiated Rate |
$15,120.20 |
| Rate for Payer: Aetna Commercial |
$14,791.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,134.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,710.55
|
| Rate for Payer: Cash Price |
$4,930.50
|
| Rate for Payer: Cigna Commercial |
$15,120.20
|
| Rate for Payer: Health EOS Commercial |
$14,627.15
|
| Rate for Payer: HFN Commercial |
$15,120.20
|
| Rate for Payer: Multiplan Commercial |
$13,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,120.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,053.15
|
| Rate for Payer: Quartz Commercial |
$9,861.00
|
| Rate for Payer: WEA Trust Commercial |
$9,039.25
|
| Rate for Payer: WPS Commercial |
$12,173.40
|
|
|
MESH VENTRALIGHT ECHO (25X30CM) 5955113
|
Facility
|
OP
|
$16,435.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4998676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,601.80 |
| Max. Negotiated Rate |
$65,740.00 |
| Rate for Payer: Aetna Commercial |
$14,791.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,134.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,601.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,682.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,710.55
|
| Rate for Payer: Cash Price |
$4,930.50
|
| Rate for Payer: Cigna Commercial |
$15,120.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,197.03
|
| Rate for Payer: Health EOS Commercial |
$14,627.15
|
| Rate for Payer: HFN Commercial |
$15,120.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,326.25
|
| Rate for Payer: Multiplan Commercial |
$13,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,120.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,053.15
|
| Rate for Payer: Quartz Commercial |
$10,682.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,861.00
|
| Rate for Payer: The Alliance Commercial |
$65,740.00
|
| Rate for Payer: WEA Trust Commercial |
$9,039.25
|
| Rate for Payer: WPS Commercial |
$12,173.40
|
|
|
MESH VENTRALIGHT ECHO 4 X 6 (10X15CM) 5955460
|
Facility
|
IP
|
$6,413.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,142.37 |
| Max. Negotiated Rate |
$5,899.96 |
| Rate for Payer: Aetna Commercial |
$5,771.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,515.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,398.89
|
| Rate for Payer: Cash Price |
$1,923.90
|
| Rate for Payer: Cigna Commercial |
$5,899.96
|
| Rate for Payer: Health EOS Commercial |
$5,707.57
|
| Rate for Payer: HFN Commercial |
$5,899.96
|
| Rate for Payer: Multiplan Commercial |
$5,130.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,847.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,899.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,142.37
|
| Rate for Payer: Quartz Commercial |
$3,847.80
|
| Rate for Payer: WEA Trust Commercial |
$3,527.15
|
| Rate for Payer: WPS Commercial |
$4,750.11
|
|
|
MESH VENTRALIGHT ECHO 4 X 6 (10X15CM) 5955460
|
Facility
|
OP
|
$6,413.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4595207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,795.64 |
| Max. Negotiated Rate |
$25,652.00 |
| Rate for Payer: Aetna Commercial |
$5,771.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,515.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,795.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,168.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,078.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,398.89
|
| Rate for Payer: Cash Price |
$1,923.90
|
| Rate for Payer: Cigna Commercial |
$5,899.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,588.71
|
| Rate for Payer: Health EOS Commercial |
$5,707.57
|
| Rate for Payer: HFN Commercial |
$5,899.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,809.75
|
| Rate for Payer: Multiplan Commercial |
$5,130.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,847.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,899.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,142.37
|
| Rate for Payer: Quartz Commercial |
$4,168.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,847.80
|
| Rate for Payer: The Alliance Commercial |
$25,652.00
|
| Rate for Payer: WEA Trust Commercial |
$3,527.15
|
| Rate for Payer: WPS Commercial |
$4,750.11
|
|
