|
ANCHOR SWIVELOCK BC 3.9 X 17.9MM AR-2326BCC
|
Facility
OP
|
$3,972.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.16 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$3,574.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,415.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,112.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,581.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,986.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,906.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.16
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Cigna Commercial |
$3,654.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,222.73
|
| Rate for Payer: Health EOS Commercial |
$3,535.08
|
| Rate for Payer: HFN Commercial |
$3,654.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,979.00
|
| Rate for Payer: Multiplan Commercial |
$3,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.28
|
| Rate for Payer: Quartz Commercial |
$2,581.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,383.20
|
| Rate for Payer: WEA Trust Commercial |
$2,184.60
|
| Rate for Payer: WPS Commercial |
$2,942.06
|
|
|
ANCHOR SWIVELOCK BC 3.9 X 17.9MM AR-2326BCC
|
Facility
IP
|
$3,972.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,946.28 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$3,574.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.16
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Cigna Commercial |
$3,654.24
|
| Rate for Payer: Health EOS Commercial |
$3,535.08
|
| Rate for Payer: HFN Commercial |
$3,654.24
|
| Rate for Payer: Multiplan Commercial |
$3,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.28
|
| Rate for Payer: Quartz Commercial |
$2,383.20
|
| Rate for Payer: WEA Trust Commercial |
$2,184.60
|
| Rate for Payer: WPS Commercial |
$2,942.06
|
|
|
ANCHOR SWIVELOCK BC 4.75 X 19.1 DOUBLE-LOAD AR-2324BCT-2
|
Facility
OP
|
$4,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$4,159.32 |
| Rate for Payer: Aetna Commercial |
$4,068.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,888.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,938.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,170.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,159.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.95
|
| Rate for Payer: Health EOS Commercial |
$4,023.69
|
| Rate for Payer: HFN Commercial |
$4,159.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,390.75
|
| Rate for Payer: Multiplan Commercial |
$3,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,712.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,159.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.29
|
| Rate for Payer: Quartz Commercial |
$2,938.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,712.60
|
| Rate for Payer: WEA Trust Commercial |
$2,486.55
|
| Rate for Payer: WPS Commercial |
$3,348.70
|
|
|
ANCHOR SWIVELOCK BC 4.75 X 19.1 DOUBLE-LOAD AR-2324BCT-2
|
Facility
IP
|
$4,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.29 |
| Max. Negotiated Rate |
$4,159.32 |
| Rate for Payer: Aetna Commercial |
$4,068.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,159.32
|
| Rate for Payer: Health EOS Commercial |
$4,023.69
|
| Rate for Payer: HFN Commercial |
$4,159.32
|
| Rate for Payer: Multiplan Commercial |
$3,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,712.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,159.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.29
|
| Rate for Payer: Quartz Commercial |
$2,712.60
|
| Rate for Payer: WEA Trust Commercial |
$2,486.55
|
| Rate for Payer: WPS Commercial |
$3,348.70
|
|
|
ANCHOR SWIVELOCK BC 5.5MM X 19.1MM DOUBLE-LOAD AR-2323BCT-2
|
Facility
OP
|
$4,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$4,159.32 |
| Rate for Payer: Aetna Commercial |
$4,068.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,888.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,938.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,170.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,159.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.95
|
| Rate for Payer: Health EOS Commercial |
$4,023.69
|
| Rate for Payer: HFN Commercial |
$4,159.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,390.75
|
| Rate for Payer: Multiplan Commercial |
$3,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,712.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,159.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.29
|
| Rate for Payer: Quartz Commercial |
$2,938.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,712.60
|
| Rate for Payer: WEA Trust Commercial |
$2,486.55
|
| Rate for Payer: WPS Commercial |
$3,348.70
|
|
|
ANCHOR SWIVELOCK BC 5.5MM X 19.1MM DOUBLE-LOAD AR-2323BCT-2
|
Facility
IP
|
$4,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.29 |
| Max. Negotiated Rate |
$4,159.32 |
| Rate for Payer: Aetna Commercial |
$4,068.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,396.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cigna Commercial |
$4,159.32
|
| Rate for Payer: Health EOS Commercial |
$4,023.69
|
| Rate for Payer: HFN Commercial |
$4,159.32
|
| Rate for Payer: Multiplan Commercial |
$3,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,712.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,159.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,215.29
|
| Rate for Payer: Quartz Commercial |
$2,712.60
|
| Rate for Payer: WEA Trust Commercial |
$2,486.55
|
| Rate for Payer: WPS Commercial |
$3,348.70
|
|
|
ANCHOR SWIVELOCK DX 3.5 X 13.5MM AR-8979P
|
Facility
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$4,462.00 |
| Rate for Payer: Aetna Commercial |
$4,365.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.50
|
| Rate for Payer: Cash Price |
$1,455.00
|
| Rate for Payer: Cigna Commercial |
$4,462.00
|
| Rate for Payer: Health EOS Commercial |
$4,316.50
|
| Rate for Payer: HFN Commercial |
$4,462.00
|
| Rate for Payer: Multiplan Commercial |
$3,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,910.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,462.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.50
|
| Rate for Payer: Quartz Commercial |
$2,910.00
|
| Rate for Payer: WEA Trust Commercial |
$2,667.50
|
| Rate for Payer: WPS Commercial |
$3,592.40
|
|
|
ANCHOR SWIVELOCK DX 3.5 X 13.5MM AR-8979P
|
Facility
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,358.00 |
| Max. Negotiated Rate |
$4,462.00 |
| Rate for Payer: Aetna Commercial |
$4,365.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,171.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,358.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,152.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,425.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,328.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.50
|
| Rate for Payer: Cash Price |
$1,455.00
|
| Rate for Payer: Cigna Commercial |
$4,462.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,714.06
|
| Rate for Payer: Health EOS Commercial |
$4,316.50
|
| Rate for Payer: HFN Commercial |
$4,462.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,637.50
|
| Rate for Payer: Multiplan Commercial |
$3,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,910.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,462.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.50
|
| Rate for Payer: Quartz Commercial |
$3,152.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,910.00
|
| Rate for Payer: WEA Trust Commercial |
$2,667.50
|
| Rate for Payer: WPS Commercial |
$3,592.40
|
|
|
ANCHOR SWIVELOCK DX KNOTLESS BC 4.75MM AR-8980BC
|
Facility
OP
|
$4,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.96 |
| Max. Negotiated Rate |
$3,732.44 |
| Rate for Payer: Aetna Commercial |
$3,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,489.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,135.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,637.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,028.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,947.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.21
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,732.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,270.30
|
| Rate for Payer: Health EOS Commercial |
$3,610.73
|
| Rate for Payer: HFN Commercial |
$3,732.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,042.75
|
| Rate for Payer: Multiplan Commercial |
$3,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,732.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,987.93
|
| Rate for Payer: Quartz Commercial |
$2,637.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,434.20
|
| Rate for Payer: WEA Trust Commercial |
$2,231.35
|
| Rate for Payer: WPS Commercial |
$3,005.02
|
|
|
ANCHOR SWIVELOCK DX KNOTLESS BC 4.75MM AR-8980BC
|
Facility
IP
|
$4,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.93 |
| Max. Negotiated Rate |
$3,732.44 |
| Rate for Payer: Aetna Commercial |
$3,651.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.21
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,732.44
|
| Rate for Payer: Health EOS Commercial |
$3,610.73
|
| Rate for Payer: HFN Commercial |
$3,732.44
|
| Rate for Payer: Multiplan Commercial |
$3,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,732.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,987.93
|
| Rate for Payer: Quartz Commercial |
$2,434.20
|
| Rate for Payer: WEA Trust Commercial |
$2,231.35
|
| Rate for Payer: WPS Commercial |
$3,005.02
|
|
|
ANCHOR SWIVELOCK KNOTLESS 4.75MM SELF-PUNCH AR-2324KBCSP
|
Facility
IP
|
$4,501.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.62 |
| Max. Negotiated Rate |
$4,141.16 |
| Rate for Payer: Aetna Commercial |
$4,051.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,385.67
|
| Rate for Payer: Cash Price |
$1,350.38
|
| Rate for Payer: Cigna Commercial |
$4,141.16
|
| Rate for Payer: Health EOS Commercial |
$4,006.12
|
| Rate for Payer: HFN Commercial |
$4,141.16
|
| Rate for Payer: Multiplan Commercial |
$3,601.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,700.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,141.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,205.62
|
| Rate for Payer: Quartz Commercial |
$2,700.76
|
| Rate for Payer: WEA Trust Commercial |
$2,475.69
|
| Rate for Payer: WPS Commercial |
$3,334.08
|
|
|
ANCHOR SWIVELOCK KNOTLESS 4.75MM SELF-PUNCH AR-2324KBCSP
|
Facility
OP
|
$4,501.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.35 |
| Max. Negotiated Rate |
$4,141.16 |
| Rate for Payer: Aetna Commercial |
$4,051.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,871.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,260.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,925.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,250.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,160.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,385.67
|
| Rate for Payer: Cash Price |
$1,350.38
|
| Rate for Payer: Cigna Commercial |
$4,141.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,518.91
|
| Rate for Payer: Health EOS Commercial |
$4,006.12
|
| Rate for Payer: HFN Commercial |
$4,141.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,375.94
|
| Rate for Payer: Multiplan Commercial |
$3,601.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,700.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,141.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,205.62
|
| Rate for Payer: Quartz Commercial |
$2,925.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,700.76
|
| Rate for Payer: WEA Trust Commercial |
$2,475.69
|
| Rate for Payer: WPS Commercial |
$3,334.08
|
|
|
ANCHOR SWIVELOCK KNOTLESS W/ TAPE 4.75MM AR-2324KBCCT
|
Facility
IP
|
$4,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.85 |
| Max. Negotiated Rate |
$3,739.80 |
| Rate for Payer: Aetna Commercial |
$3,658.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.45
|
| Rate for Payer: Cash Price |
$1,219.50
|
| Rate for Payer: Cigna Commercial |
$3,739.80
|
| Rate for Payer: Health EOS Commercial |
$3,617.85
|
| Rate for Payer: HFN Commercial |
$3,739.80
|
| Rate for Payer: Multiplan Commercial |
$3,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,739.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.85
|
| Rate for Payer: Quartz Commercial |
$2,439.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.75
|
| Rate for Payer: WPS Commercial |
$3,010.95
|
|
|
ANCHOR SWIVELOCK KNOTLESS W/ TAPE 4.75MM AR-2324KBCCT
|
Facility
OP
|
$4,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$3,739.80 |
| Rate for Payer: Aetna Commercial |
$3,658.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,138.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,642.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,032.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,951.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.45
|
| Rate for Payer: Cash Price |
$1,219.50
|
| Rate for Payer: Cigna Commercial |
$3,739.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,274.77
|
| Rate for Payer: Health EOS Commercial |
$3,617.85
|
| Rate for Payer: HFN Commercial |
$3,739.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,048.75
|
| Rate for Payer: Multiplan Commercial |
$3,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,739.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.85
|
| Rate for Payer: Quartz Commercial |
$2,642.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,439.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.75
|
| Rate for Payer: WPS Commercial |
$3,010.95
|
|
|
ANCHOR SWIVELOCK KNOTLESS W/ TIGER TAPE 4.75MM AR-2324KBCCTT
|
Facility
OP
|
$4,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$3,739.80 |
| Rate for Payer: Aetna Commercial |
$3,658.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,138.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,642.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,032.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,951.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.45
|
| Rate for Payer: Cash Price |
$1,219.50
|
| Rate for Payer: Cigna Commercial |
$3,739.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,274.77
|
| Rate for Payer: Health EOS Commercial |
$3,617.85
|
| Rate for Payer: HFN Commercial |
$3,739.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,048.75
|
| Rate for Payer: Multiplan Commercial |
$3,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,739.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.85
|
| Rate for Payer: Quartz Commercial |
$2,642.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,439.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.75
|
| Rate for Payer: WPS Commercial |
$3,010.95
|
|
|
ANCHOR SWIVELOCK KNOTLESS W/ TIGER TAPE 4.75MM AR-2324KBCCTT
|
Facility
IP
|
$4,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.85 |
| Max. Negotiated Rate |
$3,739.80 |
| Rate for Payer: Aetna Commercial |
$3,658.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.45
|
| Rate for Payer: Cash Price |
$1,219.50
|
| Rate for Payer: Cigna Commercial |
$3,739.80
|
| Rate for Payer: Health EOS Commercial |
$3,617.85
|
| Rate for Payer: HFN Commercial |
$3,739.80
|
| Rate for Payer: Multiplan Commercial |
$3,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,739.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.85
|
| Rate for Payer: Quartz Commercial |
$2,439.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.75
|
| Rate for Payer: WPS Commercial |
$3,010.95
|
|
|
ANCHOR SWIVELOCK PEEK 5.5 X 19.1MM AR-2323PSLC
|
Facility
OP
|
$5,091.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.48 |
| Max. Negotiated Rate |
$4,683.72 |
| Rate for Payer: Aetna Commercial |
$4,581.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,378.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,425.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,309.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,545.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,443.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,698.23
|
| Rate for Payer: Cash Price |
$1,527.30
|
| Rate for Payer: Cigna Commercial |
$4,683.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,848.92
|
| Rate for Payer: Health EOS Commercial |
$4,530.99
|
| Rate for Payer: HFN Commercial |
$4,683.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,818.25
|
| Rate for Payer: Multiplan Commercial |
$4,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,054.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,683.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,494.59
|
| Rate for Payer: Quartz Commercial |
$3,309.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,054.60
|
| Rate for Payer: WEA Trust Commercial |
$2,800.05
|
| Rate for Payer: WPS Commercial |
$3,770.90
|
|
|
ANCHOR SWIVELOCK PEEK 5.5 X 19.1MM AR-2323PSLC
|
Facility
IP
|
$5,091.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.59 |
| Max. Negotiated Rate |
$4,683.72 |
| Rate for Payer: Aetna Commercial |
$4,581.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,698.23
|
| Rate for Payer: Cash Price |
$1,527.30
|
| Rate for Payer: Cigna Commercial |
$4,683.72
|
| Rate for Payer: Health EOS Commercial |
$4,530.99
|
| Rate for Payer: HFN Commercial |
$4,683.72
|
| Rate for Payer: Multiplan Commercial |
$4,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,054.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,683.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,494.59
|
| Rate for Payer: Quartz Commercial |
$3,054.60
|
| Rate for Payer: WEA Trust Commercial |
$2,800.05
|
| Rate for Payer: WPS Commercial |
$3,770.90
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-10
|
Facility
IP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6190980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,853.67 |
| Max. Negotiated Rate |
$3,480.36 |
| Rate for Payer: Aetna Commercial |
$3,404.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,004.99
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,480.36
|
| Rate for Payer: Health EOS Commercial |
$3,366.87
|
| Rate for Payer: HFN Commercial |
$3,480.36
|
| Rate for Payer: Multiplan Commercial |
$3,026.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,269.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,480.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,853.67
|
| Rate for Payer: Quartz Commercial |
$2,269.80
|
| Rate for Payer: WEA Trust Commercial |
$2,080.65
|
| Rate for Payer: WPS Commercial |
$2,802.07
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-10
|
Facility
OP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6190980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.24 |
| Max. Negotiated Rate |
$3,480.36 |
| Rate for Payer: Aetna Commercial |
$3,404.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,253.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,458.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,891.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,815.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,004.99
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,480.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,116.97
|
| Rate for Payer: Health EOS Commercial |
$3,366.87
|
| Rate for Payer: HFN Commercial |
$3,480.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,837.25
|
| Rate for Payer: Multiplan Commercial |
$3,026.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,269.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,480.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,853.67
|
| Rate for Payer: Quartz Commercial |
$2,458.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,269.80
|
| Rate for Payer: WEA Trust Commercial |
$2,080.65
|
| Rate for Payer: WPS Commercial |
$2,802.07
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-4
|
Facility
IP
|
$15,744.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3739531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,714.56 |
| Max. Negotiated Rate |
$14,484.48 |
| Rate for Payer: Aetna Commercial |
$14,169.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,344.32
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cigna Commercial |
$14,484.48
|
| Rate for Payer: Health EOS Commercial |
$14,012.16
|
| Rate for Payer: HFN Commercial |
$14,484.48
|
| Rate for Payer: Multiplan Commercial |
$12,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,484.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,714.56
|
| Rate for Payer: Quartz Commercial |
$9,446.40
|
| Rate for Payer: WEA Trust Commercial |
$8,659.20
|
| Rate for Payer: WPS Commercial |
$11,661.58
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-4
|
Facility
OP
|
$15,744.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3739531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,408.32 |
| Max. Negotiated Rate |
$14,484.48 |
| Rate for Payer: Aetna Commercial |
$14,169.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,539.84
|
| Rate for Payer: Aetna Managed Medicare |
$4,408.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,233.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,872.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,344.32
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cigna Commercial |
$14,484.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,810.34
|
| Rate for Payer: Health EOS Commercial |
$14,012.16
|
| Rate for Payer: HFN Commercial |
$14,484.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,808.00
|
| Rate for Payer: Multiplan Commercial |
$12,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,484.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,714.56
|
| Rate for Payer: Quartz Commercial |
$10,233.60
|
| Rate for Payer: Quartz Medicare Advantage |
$9,446.40
|
| Rate for Payer: WEA Trust Commercial |
$8,659.20
|
| Rate for Payer: WPS Commercial |
$11,661.58
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-8
|
Facility
OP
|
$10,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,844.80 |
| Max. Negotiated Rate |
$9,347.20 |
| Rate for Payer: Aetna Commercial |
$9,144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,737.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,844.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,604.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,080.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,876.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,384.80
|
| Rate for Payer: Cash Price |
$3,048.00
|
| Rate for Payer: Cigna Commercial |
$9,347.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,685.54
|
| Rate for Payer: Health EOS Commercial |
$9,042.40
|
| Rate for Payer: HFN Commercial |
$9,347.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,620.00
|
| Rate for Payer: Multiplan Commercial |
$8,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,096.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,347.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,978.40
|
| Rate for Payer: Quartz Commercial |
$6,604.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,096.00
|
| Rate for Payer: WEA Trust Commercial |
$5,588.00
|
| Rate for Payer: WPS Commercial |
$7,525.51
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-8
|
Facility
IP
|
$10,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,978.40 |
| Max. Negotiated Rate |
$9,347.20 |
| Rate for Payer: Aetna Commercial |
$9,144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,384.80
|
| Rate for Payer: Cash Price |
$3,048.00
|
| Rate for Payer: Cigna Commercial |
$9,347.20
|
| Rate for Payer: Health EOS Commercial |
$9,042.40
|
| Rate for Payer: HFN Commercial |
$9,347.20
|
| Rate for Payer: Multiplan Commercial |
$8,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,096.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,347.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,978.40
|
| Rate for Payer: Quartz Commercial |
$6,096.00
|
| Rate for Payer: WEA Trust Commercial |
$5,588.00
|
| Rate for Payer: WPS Commercial |
$7,525.51
|
|
|
Androstenedione
|
Professional
|
$445.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
977868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$422.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.28
|
| Rate for Payer: Anthem Medicare Advantage |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.28
|
| Rate for Payer: Health EOS Commercial |
$404.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$422.75
|
| Rate for Payer: Quartz Beloit One Network |
$195.80
|
| Rate for Payer: Quartz Commercial |
$253.65
|
| Rate for Payer: Quartz Medicare Advantage |
$29.28
|
| Rate for Payer: The Alliance Commercial |
$115.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.28
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$128.83
|
|
