|
ANCHOR FIBERTAK DX SUTURE KNOTLESS W #2 SUTURE & NEEDLE AR-8991
|
Facility
IP
|
$4,222.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,068.78 |
| Max. Negotiated Rate |
$3,884.24 |
| Rate for Payer: Aetna Commercial |
$3,799.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,237.66
|
| Rate for Payer: Cash Price |
$1,266.60
|
| Rate for Payer: Cigna Commercial |
$3,884.24
|
| Rate for Payer: Health EOS Commercial |
$3,757.58
|
| Rate for Payer: HFN Commercial |
$3,884.24
|
| Rate for Payer: Multiplan Commercial |
$3,377.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,533.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,884.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,068.78
|
| Rate for Payer: Quartz Commercial |
$2,533.20
|
| Rate for Payer: WEA Trust Commercial |
$2,322.10
|
| Rate for Payer: WPS Commercial |
$3,127.24
|
|
|
ANCHOR FIBERTAK DX SUTURE KNOTLESS W #2 SUTURE & NEEDLE AR-8991
|
Facility
OP
|
$4,222.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.16 |
| Max. Negotiated Rate |
$3,884.24 |
| Rate for Payer: Aetna Commercial |
$3,799.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,630.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,182.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,744.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,026.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,237.66
|
| Rate for Payer: Cash Price |
$1,266.60
|
| Rate for Payer: Cigna Commercial |
$3,884.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,362.63
|
| Rate for Payer: Health EOS Commercial |
$3,757.58
|
| Rate for Payer: HFN Commercial |
$3,884.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,166.50
|
| Rate for Payer: Multiplan Commercial |
$3,377.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,533.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,884.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,068.78
|
| Rate for Payer: Quartz Commercial |
$2,744.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,533.20
|
| Rate for Payer: WEA Trust Commercial |
$2,322.10
|
| Rate for Payer: WPS Commercial |
$3,127.24
|
|
|
ANCHOR FIBERTAK SUTURE 2.6MM KNOTLESS AR-3641
|
Facility
OP
|
$4,603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.84 |
| Max. Negotiated Rate |
$4,234.76 |
| Rate for Payer: Aetna Commercial |
$4,142.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.59
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,234.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.84
|
| Rate for Payer: Health EOS Commercial |
$4,096.67
|
| Rate for Payer: HFN Commercial |
$4,234.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,452.25
|
| Rate for Payer: Multiplan Commercial |
$3,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.47
|
| Rate for Payer: Quartz Commercial |
$2,991.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,761.80
|
| Rate for Payer: WEA Trust Commercial |
$2,531.65
|
| Rate for Payer: WPS Commercial |
$3,409.44
|
|
|
ANCHOR FIBERTAK SUTURE 2.6MM KNOTLESS AR-3641
|
Facility
IP
|
$4,603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.47 |
| Max. Negotiated Rate |
$4,234.76 |
| Rate for Payer: Aetna Commercial |
$4,142.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.59
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,234.76
|
| Rate for Payer: Health EOS Commercial |
$4,096.67
|
| Rate for Payer: HFN Commercial |
$4,234.76
|
| Rate for Payer: Multiplan Commercial |
$3,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.47
|
| Rate for Payer: Quartz Commercial |
$2,761.80
|
| Rate for Payer: WEA Trust Commercial |
$2,531.65
|
| Rate for Payer: WPS Commercial |
$3,409.44
|
|
|
ANCHOR FIBERTAK SUTURE AR-3600
|
Facility
IP
|
$5,671.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,778.79 |
| Max. Negotiated Rate |
$5,217.32 |
| Rate for Payer: Aetna Commercial |
$5,103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,005.63
|
| Rate for Payer: Cash Price |
$1,701.30
|
| Rate for Payer: Cigna Commercial |
$5,217.32
|
| Rate for Payer: Health EOS Commercial |
$5,047.19
|
| Rate for Payer: HFN Commercial |
$5,217.32
|
| Rate for Payer: Multiplan Commercial |
$4,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,778.79
|
| Rate for Payer: Quartz Commercial |
$3,402.60
|
| Rate for Payer: WEA Trust Commercial |
$3,119.05
|
| Rate for Payer: WPS Commercial |
$4,200.51
|
|
|
ANCHOR FIBERTAK SUTURE AR-3600
|
Facility
OP
|
$5,671.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,587.88 |
| Max. Negotiated Rate |
$5,217.32 |
| Rate for Payer: Aetna Commercial |
$5,103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,877.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,587.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,686.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,835.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,722.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,005.63
|
| Rate for Payer: Cash Price |
$1,701.30
|
| Rate for Payer: Cigna Commercial |
$5,217.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,173.49
|
| Rate for Payer: Health EOS Commercial |
$5,047.19
|
| Rate for Payer: HFN Commercial |
$5,217.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,253.25
|
| Rate for Payer: Multiplan Commercial |
$4,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,778.79
|
| Rate for Payer: Quartz Commercial |
$3,686.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,402.60
|
| Rate for Payer: WEA Trust Commercial |
$3,119.05
|
| Rate for Payer: WPS Commercial |
$4,200.51
|
|
|
ANCHOR FIBERTAK SUTURE AR-3602
|
Facility
IP
|
$3,217.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5074796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$2,959.64 |
| Rate for Payer: Aetna Commercial |
$2,895.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,705.01
|
| Rate for Payer: Cash Price |
$965.10
|
| Rate for Payer: Cigna Commercial |
$2,959.64
|
| Rate for Payer: Health EOS Commercial |
$2,863.13
|
| Rate for Payer: HFN Commercial |
$2,959.64
|
| Rate for Payer: Multiplan Commercial |
$2,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,959.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,576.33
|
| Rate for Payer: Quartz Commercial |
$1,930.20
|
| Rate for Payer: WEA Trust Commercial |
$1,769.35
|
| Rate for Payer: WPS Commercial |
$2,382.83
|
|
|
ANCHOR FIBERTAK SUTURE AR-3602
|
Facility
OP
|
$3,217.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5074796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.76 |
| Max. Negotiated Rate |
$2,959.64 |
| Rate for Payer: Aetna Commercial |
$2,895.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,766.62
|
| Rate for Payer: Aetna Managed Medicare |
$900.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,091.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,608.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,544.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,705.01
|
| Rate for Payer: Cash Price |
$965.10
|
| Rate for Payer: Cigna Commercial |
$2,959.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,800.23
|
| Rate for Payer: Health EOS Commercial |
$2,863.13
|
| Rate for Payer: HFN Commercial |
$2,959.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,412.75
|
| Rate for Payer: Multiplan Commercial |
$2,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,930.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,959.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,576.33
|
| Rate for Payer: Quartz Commercial |
$2,091.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,930.20
|
| Rate for Payer: WEA Trust Commercial |
$1,769.35
|
| Rate for Payer: WPS Commercial |
$2,382.83
|
|
|
ANCHOR FIBERTAK SUTURE DX W 1.3MM FIBERWIRE SUTURE TAPE (W/BL) & NEEDLE AR-8990ST
|
Facility
IP
|
$5,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,599.94 |
| Max. Negotiated Rate |
$4,881.52 |
| Rate for Payer: Aetna Commercial |
$4,775.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,812.18
|
| Rate for Payer: Cash Price |
$1,591.80
|
| Rate for Payer: Cigna Commercial |
$4,881.52
|
| Rate for Payer: Health EOS Commercial |
$4,722.34
|
| Rate for Payer: HFN Commercial |
$4,881.52
|
| Rate for Payer: Multiplan Commercial |
$4,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,881.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,599.94
|
| Rate for Payer: Quartz Commercial |
$3,183.60
|
| Rate for Payer: WEA Trust Commercial |
$2,918.30
|
| Rate for Payer: WPS Commercial |
$3,930.15
|
|
|
ANCHOR FIBERTAK SUTURE DX W 1.3MM FIBERWIRE SUTURE TAPE (W/BL) & NEEDLE AR-8990ST
|
Facility
OP
|
$5,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,485.68 |
| Max. Negotiated Rate |
$4,881.52 |
| Rate for Payer: Aetna Commercial |
$4,775.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,563.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,485.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,448.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,546.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,812.18
|
| Rate for Payer: Cash Price |
$1,591.80
|
| Rate for Payer: Cigna Commercial |
$4,881.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,969.24
|
| Rate for Payer: Health EOS Commercial |
$4,722.34
|
| Rate for Payer: HFN Commercial |
$4,881.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,979.50
|
| Rate for Payer: Multiplan Commercial |
$4,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,881.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,599.94
|
| Rate for Payer: Quartz Commercial |
$3,448.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,183.60
|
| Rate for Payer: WEA Trust Commercial |
$2,918.30
|
| Rate for Payer: WPS Commercial |
$3,930.15
|
|
|
ANCHOR FIBERTAK SUTURE KNOTLESS AR-3636
|
Facility
OP
|
$4,131.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.68 |
| Max. Negotiated Rate |
$3,800.52 |
| Rate for Payer: Aetna Commercial |
$3,717.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,552.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,156.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,685.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,065.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,982.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,189.43
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna Commercial |
$3,800.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,311.71
|
| Rate for Payer: Health EOS Commercial |
$3,676.59
|
| Rate for Payer: HFN Commercial |
$3,800.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,098.25
|
| Rate for Payer: Multiplan Commercial |
$3,304.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,478.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,800.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,024.19
|
| Rate for Payer: Quartz Commercial |
$2,685.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,478.60
|
| Rate for Payer: WEA Trust Commercial |
$2,272.05
|
| Rate for Payer: WPS Commercial |
$3,059.83
|
|
|
ANCHOR FIBERTAK SUTURE KNOTLESS AR-3636
|
Facility
IP
|
$4,131.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,024.19 |
| Max. Negotiated Rate |
$3,800.52 |
| Rate for Payer: Aetna Commercial |
$3,717.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,189.43
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna Commercial |
$3,800.52
|
| Rate for Payer: Health EOS Commercial |
$3,676.59
|
| Rate for Payer: HFN Commercial |
$3,800.52
|
| Rate for Payer: Multiplan Commercial |
$3,304.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,478.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,800.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,024.19
|
| Rate for Payer: Quartz Commercial |
$2,478.60
|
| Rate for Payer: WEA Trust Commercial |
$2,272.05
|
| Rate for Payer: WPS Commercial |
$3,059.83
|
|
|
ANCHOR FIBERTAK SUTURE KNOTLESS AR-3638/AR-3636
|
Facility
OP
|
$4,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,351.28 |
| Max. Negotiated Rate |
$4,439.92 |
| Rate for Payer: Aetna Commercial |
$4,343.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,150.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,351.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,136.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,316.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,557.78
|
| Rate for Payer: Cash Price |
$1,447.80
|
| Rate for Payer: Cigna Commercial |
$4,439.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,700.63
|
| Rate for Payer: Health EOS Commercial |
$4,295.14
|
| Rate for Payer: HFN Commercial |
$4,439.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,619.50
|
| Rate for Payer: Multiplan Commercial |
$3,860.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,895.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,439.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,364.74
|
| Rate for Payer: Quartz Commercial |
$3,136.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,895.60
|
| Rate for Payer: WEA Trust Commercial |
$2,654.30
|
| Rate for Payer: WPS Commercial |
$3,574.62
|
|
|
ANCHOR FIBERTAK SUTURE KNOTLESS AR-3638/AR-3636
|
Facility
IP
|
$4,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.74 |
| Max. Negotiated Rate |
$4,439.92 |
| Rate for Payer: Aetna Commercial |
$4,343.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,557.78
|
| Rate for Payer: Cash Price |
$1,447.80
|
| Rate for Payer: Cigna Commercial |
$4,439.92
|
| Rate for Payer: Health EOS Commercial |
$4,295.14
|
| Rate for Payer: HFN Commercial |
$4,439.92
|
| Rate for Payer: Multiplan Commercial |
$3,860.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,895.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,439.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,364.74
|
| Rate for Payer: Quartz Commercial |
$2,895.60
|
| Rate for Payer: WEA Trust Commercial |
$2,654.30
|
| Rate for Payer: WPS Commercial |
$3,574.62
|
|
|
ANCHOR FIBERTAK SUTURE RC DOUBLOAD TAPE BL/W BLK/W AR-3632
|
Facility
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5385070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.24 |
| Max. Negotiated Rate |
$1,173.92 |
| Rate for Payer: Aetna Commercial |
$1,148.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.28
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,173.92
|
| Rate for Payer: Health EOS Commercial |
$1,135.64
|
| Rate for Payer: HFN Commercial |
$1,173.92
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.92
|
| Rate for Payer: Quartz Beloit One Network |
$625.24
|
| Rate for Payer: Quartz Commercial |
$765.60
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
ANCHOR FIBERTAK SUTURE RC DOUBLOAD TAPE BL/W BLK/W AR-3632
|
Facility
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5385070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.28 |
| Max. Negotiated Rate |
$1,173.92 |
| Rate for Payer: Aetna Commercial |
$1,148.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Aetna Managed Medicare |
$357.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.28
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,173.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.05
|
| Rate for Payer: Health EOS Commercial |
$1,135.64
|
| Rate for Payer: HFN Commercial |
$1,173.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.00
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.92
|
| Rate for Payer: Quartz Beloit One Network |
$625.24
|
| Rate for Payer: Quartz Commercial |
$829.40
|
| Rate for Payer: Quartz Medicare Advantage |
$765.60
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
ANCHOR FIBERTAK SUTURE RC TRIPLOAD TAPE BL/W BLK/WW SELF-LOAD AR-3633SP
|
Facility
OP
|
$4,032.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.96 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$3,628.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,467.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,128.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,620.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,935.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,136.96
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cigna Commercial |
$3,709.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,256.31
|
| Rate for Payer: Health EOS Commercial |
$3,588.48
|
| Rate for Payer: HFN Commercial |
$3,709.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,024.00
|
| Rate for Payer: Multiplan Commercial |
$3,225.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,419.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,709.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,975.68
|
| Rate for Payer: Quartz Commercial |
$2,620.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,419.20
|
| Rate for Payer: WEA Trust Commercial |
$2,217.60
|
| Rate for Payer: WPS Commercial |
$2,986.50
|
|
|
ANCHOR FIBERTAK SUTURE RC TRIPLOAD TAPE BL/W BLK/WW SELF-LOAD AR-3633SP
|
Facility
IP
|
$4,032.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.68 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$3,628.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,136.96
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cigna Commercial |
$3,709.44
|
| Rate for Payer: Health EOS Commercial |
$3,588.48
|
| Rate for Payer: HFN Commercial |
$3,709.44
|
| Rate for Payer: Multiplan Commercial |
$3,225.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,419.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,709.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,975.68
|
| Rate for Payer: Quartz Commercial |
$2,419.20
|
| Rate for Payer: WEA Trust Commercial |
$2,217.60
|
| Rate for Payer: WPS Commercial |
$2,986.50
|
|
|
ANCHOR GII QUICKANCHOR PLUS 212034
|
Facility
IP
|
$3,447.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.03 |
| Max. Negotiated Rate |
$3,171.24 |
| Rate for Payer: Aetna Commercial |
$3,102.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.91
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,171.24
|
| Rate for Payer: Health EOS Commercial |
$3,067.83
|
| Rate for Payer: HFN Commercial |
$3,171.24
|
| Rate for Payer: Multiplan Commercial |
$2,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,068.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,689.03
|
| Rate for Payer: Quartz Commercial |
$2,068.20
|
| Rate for Payer: WEA Trust Commercial |
$1,895.85
|
| Rate for Payer: WPS Commercial |
$2,553.19
|
|
|
ANCHOR GII QUICKANCHOR PLUS 212034
|
Facility
OP
|
$3,447.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.16 |
| Max. Negotiated Rate |
$3,171.24 |
| Rate for Payer: Aetna Commercial |
$3,102.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.42
|
| Rate for Payer: Aetna Managed Medicare |
$965.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,240.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,723.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,654.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.91
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,171.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,928.94
|
| Rate for Payer: Health EOS Commercial |
$3,067.83
|
| Rate for Payer: HFN Commercial |
$3,171.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,585.25
|
| Rate for Payer: Multiplan Commercial |
$2,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,068.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,689.03
|
| Rate for Payer: Quartz Commercial |
$2,240.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,068.20
|
| Rate for Payer: WEA Trust Commercial |
$1,895.85
|
| Rate for Payer: WPS Commercial |
$2,553.19
|
|
|
ANCHOR GII QUICKANCHOR WITH ORTHOCORD 222983
|
Facility
OP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.04 |
| Max. Negotiated Rate |
$5,490.56 |
| Rate for Payer: Aetna Commercial |
$5,371.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,132.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,671.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,879.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,864.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,163.04
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cigna Commercial |
$5,490.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,339.69
|
| Rate for Payer: Health EOS Commercial |
$5,311.52
|
| Rate for Payer: HFN Commercial |
$5,490.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,476.00
|
| Rate for Payer: Multiplan Commercial |
$4,774.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,490.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,924.32
|
| Rate for Payer: Quartz Commercial |
$3,879.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,580.80
|
| Rate for Payer: WEA Trust Commercial |
$3,282.40
|
| Rate for Payer: WPS Commercial |
$4,420.50
|
|
|
ANCHOR GII QUICKANCHOR WITH ORTHOCORD 222983
|
Facility
IP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.32 |
| Max. Negotiated Rate |
$5,490.56 |
| Rate for Payer: Aetna Commercial |
$5,371.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,163.04
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cigna Commercial |
$5,490.56
|
| Rate for Payer: Health EOS Commercial |
$5,311.52
|
| Rate for Payer: HFN Commercial |
$5,490.56
|
| Rate for Payer: Multiplan Commercial |
$4,774.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,490.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,924.32
|
| Rate for Payer: Quartz Commercial |
$3,580.80
|
| Rate for Payer: WEA Trust Commercial |
$3,282.40
|
| Rate for Payer: WPS Commercial |
$4,420.50
|
|
|
ANCHOR JUGGERKNOT 2.9MM #2 BLUE MAXBRAID SINGLE 912029
|
Facility
IP
|
$4,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,190.79 |
| Max. Negotiated Rate |
$4,113.32 |
| Rate for Payer: Aetna Commercial |
$4,023.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.63
|
| Rate for Payer: Cash Price |
$1,341.30
|
| Rate for Payer: Cigna Commercial |
$4,113.32
|
| Rate for Payer: Health EOS Commercial |
$3,979.19
|
| Rate for Payer: HFN Commercial |
$4,113.32
|
| Rate for Payer: Multiplan Commercial |
$3,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,682.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,113.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.79
|
| Rate for Payer: Quartz Commercial |
$2,682.60
|
| Rate for Payer: WEA Trust Commercial |
$2,459.05
|
| Rate for Payer: WPS Commercial |
$3,311.67
|
|
|
ANCHOR JUGGERKNOT 2.9MM #2 BLUE MAXBRAID SINGLE 912029
|
Facility
OP
|
$4,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.88 |
| Max. Negotiated Rate |
$4,113.32 |
| Rate for Payer: Aetna Commercial |
$4,023.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,845.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,906.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,235.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,146.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.63
|
| Rate for Payer: Cash Price |
$1,341.30
|
| Rate for Payer: Cigna Commercial |
$4,113.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,501.97
|
| Rate for Payer: Health EOS Commercial |
$3,979.19
|
| Rate for Payer: HFN Commercial |
$4,113.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,353.25
|
| Rate for Payer: Multiplan Commercial |
$3,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,682.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,113.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.79
|
| Rate for Payer: Quartz Commercial |
$2,906.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,682.60
|
| Rate for Payer: WEA Trust Commercial |
$2,459.05
|
| Rate for Payer: WPS Commercial |
$3,311.67
|
|
|
ANCHOR MICROFIX QUICKANCHOR 212855
|
Facility
OP
|
$4,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.56 |
| Max. Negotiated Rate |
$4,187.84 |
| Rate for Payer: Aetna Commercial |
$4,096.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,914.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,274.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,958.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,276.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,184.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,412.56
|
| Rate for Payer: Cash Price |
$1,365.60
|
| Rate for Payer: Cigna Commercial |
$4,187.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,547.30
|
| Rate for Payer: Health EOS Commercial |
$4,051.28
|
| Rate for Payer: HFN Commercial |
$4,187.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,414.00
|
| Rate for Payer: Multiplan Commercial |
$3,641.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,731.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,187.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,230.48
|
| Rate for Payer: Quartz Commercial |
$2,958.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,731.20
|
| Rate for Payer: WEA Trust Commercial |
$2,503.60
|
| Rate for Payer: WPS Commercial |
$3,371.67
|
|
