|
ANCA Vasculitides
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
ANCHOR 3.0 BIO-SUTURE 1934BCFT
|
Facility
IP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,546.93 |
| Max. Negotiated Rate |
$2,904.44 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.21
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cigna Commercial |
$2,904.44
|
| Rate for Payer: Health EOS Commercial |
$2,809.73
|
| Rate for Payer: HFN Commercial |
$2,904.44
|
| Rate for Payer: Multiplan Commercial |
$2,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,894.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,904.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,546.93
|
| Rate for Payer: Quartz Commercial |
$1,894.20
|
| Rate for Payer: WEA Trust Commercial |
$1,736.35
|
| Rate for Payer: WPS Commercial |
$2,338.39
|
|
|
ANCHOR 3.0 BIO-SUTURE 1934BCFT
|
Facility
OP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$883.96 |
| Max. Negotiated Rate |
$2,904.44 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,715.02
|
| Rate for Payer: Aetna Managed Medicare |
$883.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,052.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,578.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,515.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.21
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cigna Commercial |
$2,904.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,766.66
|
| Rate for Payer: Health EOS Commercial |
$2,809.73
|
| Rate for Payer: HFN Commercial |
$2,904.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,367.75
|
| Rate for Payer: Multiplan Commercial |
$2,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,894.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,904.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,546.93
|
| Rate for Payer: Quartz Commercial |
$2,052.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,894.20
|
| Rate for Payer: WEA Trust Commercial |
$1,736.35
|
| Rate for Payer: WPS Commercial |
$2,338.39
|
|
|
ANCHOR 3.0 BIO-SUTURETAK FIBER AR-1934BCF
|
Facility
OP
|
$5,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,489.88 |
| Max. Negotiated Rate |
$4,895.32 |
| Rate for Payer: Aetna Commercial |
$4,788.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,576.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,489.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,458.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,660.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,554.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,820.13
|
| Rate for Payer: Cash Price |
$1,596.30
|
| Rate for Payer: Cigna Commercial |
$4,895.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,977.63
|
| Rate for Payer: Health EOS Commercial |
$4,735.69
|
| Rate for Payer: HFN Commercial |
$4,895.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,990.75
|
| Rate for Payer: Multiplan Commercial |
$4,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,895.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,607.29
|
| Rate for Payer: Quartz Commercial |
$3,458.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,192.60
|
| Rate for Payer: WEA Trust Commercial |
$2,926.55
|
| Rate for Payer: WPS Commercial |
$3,941.26
|
|
|
ANCHOR 3.0 BIO-SUTURETAK FIBER AR-1934BCF
|
Facility
IP
|
$5,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.29 |
| Max. Negotiated Rate |
$4,895.32 |
| Rate for Payer: Aetna Commercial |
$4,788.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,820.13
|
| Rate for Payer: Cash Price |
$1,596.30
|
| Rate for Payer: Cigna Commercial |
$4,895.32
|
| Rate for Payer: Health EOS Commercial |
$4,735.69
|
| Rate for Payer: HFN Commercial |
$4,895.32
|
| Rate for Payer: Multiplan Commercial |
$4,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,895.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,607.29
|
| Rate for Payer: Quartz Commercial |
$3,192.60
|
| Rate for Payer: WEA Trust Commercial |
$2,926.55
|
| Rate for Payer: WPS Commercial |
$3,941.26
|
|
|
ANCHOR 3.0 BIO-SUTURETAK TIGER AR-1934BCFT-2
|
Facility
IP
|
$5,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,780.75 |
| Max. Negotiated Rate |
$5,221.00 |
| Rate for Payer: Aetna Commercial |
$5,107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,007.75
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$5,221.00
|
| Rate for Payer: Health EOS Commercial |
$5,050.75
|
| Rate for Payer: HFN Commercial |
$5,221.00
|
| Rate for Payer: Multiplan Commercial |
$4,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,221.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.75
|
| Rate for Payer: Quartz Commercial |
$3,405.00
|
| Rate for Payer: WEA Trust Commercial |
$3,121.25
|
| Rate for Payer: WPS Commercial |
$4,203.47
|
|
|
ANCHOR 3.0 BIO-SUTURETAK TIGER AR-1934BCFT-2
|
Facility
OP
|
$5,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,589.00 |
| Max. Negotiated Rate |
$5,221.00 |
| Rate for Payer: Aetna Commercial |
$5,107.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,880.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,589.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,688.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,837.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,724.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,007.75
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$5,221.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,175.73
|
| Rate for Payer: Health EOS Commercial |
$5,050.75
|
| Rate for Payer: HFN Commercial |
$5,221.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,256.25
|
| Rate for Payer: Multiplan Commercial |
$4,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,221.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.75
|
| Rate for Payer: Quartz Commercial |
$3,688.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,405.00
|
| Rate for Payer: WEA Trust Commercial |
$3,121.25
|
| Rate for Payer: WPS Commercial |
$4,203.47
|
|
|
ANCHOR 3.5 X 10MM CORKSCREW FT AR-1915FT
|
Facility
OP
|
$4,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5813659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.72 |
| Max. Negotiated Rate |
$3,840.08 |
| Rate for Payer: Aetna Commercial |
$3,756.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,589.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,168.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,713.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,003.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.22
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,840.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,335.77
|
| Rate for Payer: Health EOS Commercial |
$3,714.86
|
| Rate for Payer: HFN Commercial |
$3,840.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,130.50
|
| Rate for Payer: Multiplan Commercial |
$3,339.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,504.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.26
|
| Rate for Payer: Quartz Commercial |
$2,713.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,504.40
|
| Rate for Payer: WEA Trust Commercial |
$2,295.70
|
| Rate for Payer: WPS Commercial |
$3,091.68
|
|
|
ANCHOR 3.5 X 10MM CORKSCREW FT AR-1915FT
|
Facility
IP
|
$4,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5813659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.26 |
| Max. Negotiated Rate |
$3,840.08 |
| Rate for Payer: Aetna Commercial |
$3,756.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.22
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,840.08
|
| Rate for Payer: Health EOS Commercial |
$3,714.86
|
| Rate for Payer: HFN Commercial |
$3,840.08
|
| Rate for Payer: Multiplan Commercial |
$3,339.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,504.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.26
|
| Rate for Payer: Quartz Commercial |
$2,504.40
|
| Rate for Payer: WEA Trust Commercial |
$2,295.70
|
| Rate for Payer: WPS Commercial |
$3,091.68
|
|
|
ANCHOR 5.5 BC CORKSCREW FT VENTED AR-1927BCT
|
Facility
OP
|
$4,324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5107365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
ANCHOR 5.5 BC CORKSCREW FT VENTED AR-1927BCT
|
Facility
IP
|
$4,324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5107365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
ANCHOR 5.5 BIO-CORK AR-1927BFT
|
Facility
IP
|
$3,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.71 |
| Max. Negotiated Rate |
$3,016.68 |
| Rate for Payer: Aetna Commercial |
$2,951.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.87
|
| Rate for Payer: Cash Price |
$983.70
|
| Rate for Payer: Cigna Commercial |
$3,016.68
|
| Rate for Payer: Health EOS Commercial |
$2,918.31
|
| Rate for Payer: HFN Commercial |
$3,016.68
|
| Rate for Payer: Multiplan Commercial |
$2,623.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,967.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,016.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.71
|
| Rate for Payer: Quartz Commercial |
$1,967.40
|
| Rate for Payer: WEA Trust Commercial |
$1,803.45
|
| Rate for Payer: WPS Commercial |
$2,428.76
|
|
|
ANCHOR 5.5 BIO-CORK AR-1927BFT
|
Facility
OP
|
$3,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.12 |
| Max. Negotiated Rate |
$3,016.68 |
| Rate for Payer: Aetna Commercial |
$2,951.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.94
|
| Rate for Payer: Aetna Managed Medicare |
$918.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,131.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,639.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,573.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.87
|
| Rate for Payer: Cash Price |
$983.70
|
| Rate for Payer: Cigna Commercial |
$3,016.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,834.93
|
| Rate for Payer: Health EOS Commercial |
$2,918.31
|
| Rate for Payer: HFN Commercial |
$3,016.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,459.25
|
| Rate for Payer: Multiplan Commercial |
$2,623.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,967.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,016.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.71
|
| Rate for Payer: Quartz Commercial |
$2,131.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,967.40
|
| Rate for Payer: WEA Trust Commercial |
$1,803.45
|
| Rate for Payer: WPS Commercial |
$2,428.76
|
|
|
ANCHOR 5.5 HEALIX 222233
|
Facility
IP
|
$4,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.90 |
| Max. Negotiated Rate |
$4,057.20 |
| Rate for Payer: Aetna Commercial |
$3,969.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.30
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,057.20
|
| Rate for Payer: Health EOS Commercial |
$3,924.90
|
| Rate for Payer: HFN Commercial |
$4,057.20
|
| Rate for Payer: Multiplan Commercial |
$3,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,057.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.90
|
| Rate for Payer: Quartz Commercial |
$2,646.00
|
| Rate for Payer: WEA Trust Commercial |
$2,425.50
|
| Rate for Payer: WPS Commercial |
$3,266.49
|
|
|
ANCHOR 5.5 HEALIX 222233
|
Facility
OP
|
$4,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,234.80 |
| Max. Negotiated Rate |
$4,057.20 |
| Rate for Payer: Aetna Commercial |
$3,969.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,792.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,866.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,116.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.30
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,057.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,467.84
|
| Rate for Payer: Health EOS Commercial |
$3,924.90
|
| Rate for Payer: HFN Commercial |
$4,057.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,307.50
|
| Rate for Payer: Multiplan Commercial |
$3,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,057.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.90
|
| Rate for Payer: Quartz Commercial |
$2,866.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,646.00
|
| Rate for Payer: WEA Trust Commercial |
$2,425.50
|
| Rate for Payer: WPS Commercial |
$3,266.49
|
|
|
ANCHOR 5.5MM HEALIX PEEK 222209
|
Facility
IP
|
$4,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,985.48 |
| Max. Negotiated Rate |
$3,727.84 |
| Rate for Payer: Aetna Commercial |
$3,646.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,147.56
|
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cigna Commercial |
$3,727.84
|
| Rate for Payer: Health EOS Commercial |
$3,606.28
|
| Rate for Payer: HFN Commercial |
$3,727.84
|
| Rate for Payer: Multiplan Commercial |
$3,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,431.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,985.48
|
| Rate for Payer: Quartz Commercial |
$2,431.20
|
| Rate for Payer: WEA Trust Commercial |
$2,228.60
|
| Rate for Payer: WPS Commercial |
$3,001.32
|
|
|
ANCHOR 5.5MM HEALIX PEEK 222209
|
Facility
OP
|
$4,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.56 |
| Max. Negotiated Rate |
$3,727.84 |
| Rate for Payer: Aetna Commercial |
$3,646.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,484.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,134.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,633.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,026.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,944.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,147.56
|
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cigna Commercial |
$3,727.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,267.50
|
| Rate for Payer: Health EOS Commercial |
$3,606.28
|
| Rate for Payer: HFN Commercial |
$3,727.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,039.00
|
| Rate for Payer: Multiplan Commercial |
$3,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,431.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,985.48
|
| Rate for Payer: Quartz Commercial |
$2,633.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,431.20
|
| Rate for Payer: WEA Trust Commercial |
$2,228.60
|
| Rate for Payer: WPS Commercial |
$3,001.32
|
|
|
ANCHOR 6.5 BIO-CORK AR-1925BF
|
Facility
IP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,546.93 |
| Max. Negotiated Rate |
$2,904.44 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.21
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cigna Commercial |
$2,904.44
|
| Rate for Payer: Health EOS Commercial |
$2,809.73
|
| Rate for Payer: HFN Commercial |
$2,904.44
|
| Rate for Payer: Multiplan Commercial |
$2,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,894.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,904.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,546.93
|
| Rate for Payer: Quartz Commercial |
$1,894.20
|
| Rate for Payer: WEA Trust Commercial |
$1,736.35
|
| Rate for Payer: WPS Commercial |
$2,338.39
|
|
|
ANCHOR 6.5 BIO-CORK AR-1925BF
|
Facility
OP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$883.96 |
| Max. Negotiated Rate |
$2,904.44 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,715.02
|
| Rate for Payer: Aetna Managed Medicare |
$883.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,052.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,578.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,515.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.21
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cigna Commercial |
$2,904.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,766.66
|
| Rate for Payer: Health EOS Commercial |
$2,809.73
|
| Rate for Payer: HFN Commercial |
$2,904.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,367.75
|
| Rate for Payer: Multiplan Commercial |
$2,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,894.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,904.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,546.93
|
| Rate for Payer: Quartz Commercial |
$2,052.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,894.20
|
| Rate for Payer: WEA Trust Commercial |
$1,736.35
|
| Rate for Payer: WPS Commercial |
$2,338.39
|
|
|
ANCHOR BIO-SUTURETAK KNOTLESS AR-1938BC
|
Facility
OP
|
$4,663.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,305.64 |
| Max. Negotiated Rate |
$4,289.96 |
| Rate for Payer: Aetna Commercial |
$4,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,305.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,238.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.39
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,289.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,609.41
|
| Rate for Payer: Health EOS Commercial |
$4,150.07
|
| Rate for Payer: HFN Commercial |
$4,289.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,497.25
|
| Rate for Payer: Multiplan Commercial |
$3,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,289.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,284.87
|
| Rate for Payer: Quartz Commercial |
$3,030.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,797.80
|
| Rate for Payer: WEA Trust Commercial |
$2,564.65
|
| Rate for Payer: WPS Commercial |
$3,453.88
|
|
|
ANCHOR BIO-SUTURETAK KNOTLESS AR-1938BC
|
Facility
IP
|
$4,663.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.87 |
| Max. Negotiated Rate |
$4,289.96 |
| Rate for Payer: Aetna Commercial |
$4,196.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.39
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,289.96
|
| Rate for Payer: Health EOS Commercial |
$4,150.07
|
| Rate for Payer: HFN Commercial |
$4,289.96
|
| Rate for Payer: Multiplan Commercial |
$3,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,289.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,284.87
|
| Rate for Payer: Quartz Commercial |
$2,797.80
|
| Rate for Payer: WEA Trust Commercial |
$2,564.65
|
| Rate for Payer: WPS Commercial |
$3,453.88
|
|
|
ANCHOR BIO-SWIVELOCK SUTURE
|
Facility
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.00 |
| Max. Negotiated Rate |
$4,278.00 |
| Rate for Payer: Aetna Commercial |
$4,185.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,999.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,022.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,232.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.50
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,602.14
|
| Rate for Payer: Health EOS Commercial |
$4,138.50
|
| Rate for Payer: HFN Commercial |
$4,278.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,487.50
|
| Rate for Payer: Multiplan Commercial |
$3,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,278.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.50
|
| Rate for Payer: Quartz Commercial |
$3,022.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,790.00
|
| Rate for Payer: WEA Trust Commercial |
$2,557.50
|
| Rate for Payer: WPS Commercial |
$3,444.26
|
|
|
ANCHOR BIO-SWIVELOCK SUTURE
|
Facility
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.50 |
| Max. Negotiated Rate |
$4,278.00 |
| Rate for Payer: Aetna Commercial |
$4,185.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.50
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,278.00
|
| Rate for Payer: Health EOS Commercial |
$4,138.50
|
| Rate for Payer: HFN Commercial |
$4,278.00
|
| Rate for Payer: Multiplan Commercial |
$3,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,278.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.50
|
| Rate for Payer: Quartz Commercial |
$2,790.00
|
| Rate for Payer: WEA Trust Commercial |
$2,557.50
|
| Rate for Payer: WPS Commercial |
$3,444.26
|
|
|
ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP TIGER TAPE ((WHITE/BLACK) AR-3653SP
|
Facility
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6212989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.16 |
| Max. Negotiated Rate |
$3,631.24 |
| Rate for Payer: Aetna Commercial |
$3,552.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,394.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,105.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,565.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,894.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.91
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,631.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,208.74
|
| Rate for Payer: Health EOS Commercial |
$3,512.83
|
| Rate for Payer: HFN Commercial |
$3,631.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,960.25
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.03
|
| Rate for Payer: Quartz Commercial |
$2,565.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,368.20
|
| Rate for Payer: WEA Trust Commercial |
$2,170.85
|
| Rate for Payer: WPS Commercial |
$2,923.54
|
|
|
ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP TIGER TAPE ((WHITE/BLACK) AR-3653SP
|
Facility
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6212989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,934.03 |
| Max. Negotiated Rate |
$3,631.24 |
| Rate for Payer: Aetna Commercial |
$3,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.91
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,631.24
|
| Rate for Payer: Health EOS Commercial |
$3,512.83
|
| Rate for Payer: HFN Commercial |
$3,631.24
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.03
|
| Rate for Payer: Quartz Commercial |
$2,368.20
|
| Rate for Payer: WEA Trust Commercial |
$2,170.85
|
| Rate for Payer: WPS Commercial |
$2,923.54
|
|
