|
ANCA
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
5438976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
ANCA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
5438976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
ANCA
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
5438976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
ANCA Screen with MPO and PR3
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5675624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$61.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
|
ANCA Screen with MPO and PR3
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5675624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
ANCA Screen with MPO and PR3
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5675624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$180.18
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
ANCA Vasculitides
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$61.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
|
ANCA Vasculitides
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
ANCA Vasculitides
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$180.18
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
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 |
$919.32 |
| Max. Negotiated Rate |
$3,020.62 |
| Rate for Payer: Aetna Commercial |
$2,954.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.62
|
| Rate for Payer: Aetna Managed Medicare |
$919.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,134.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,740.14
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cigna Commercial |
$3,020.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.37
|
| Rate for Payer: Health EOS Commercial |
$2,922.12
|
| Rate for Payer: HFN Commercial |
$3,020.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.46
|
| Rate for Payer: Multiplan Commercial |
$2,626.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.81
|
| Rate for Payer: Quartz Commercial |
$2,134.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.97
|
| Rate for Payer: The Alliance Commercial |
$1,641.64
|
| Rate for Payer: WEA Trust Commercial |
$1,805.80
|
| Rate for Payer: WPS Commercial |
$2,431.84
|
|
|
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 |
$1,608.81 |
| Max. Negotiated Rate |
$3,020.62 |
| Rate for Payer: Aetna Commercial |
$2,954.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,740.14
|
| Rate for Payer: Cash Price |
$947.10
|
| Rate for Payer: Cigna Commercial |
$3,020.62
|
| Rate for Payer: Health EOS Commercial |
$2,922.12
|
| Rate for Payer: HFN Commercial |
$3,020.62
|
| Rate for Payer: Multiplan Commercial |
$2,626.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.81
|
| Rate for Payer: Quartz Commercial |
$1,969.97
|
| Rate for Payer: WEA Trust Commercial |
$1,805.80
|
| Rate for Payer: WPS Commercial |
$2,431.84
|
|
|
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 |
$1,549.48 |
| Max. Negotiated Rate |
$5,091.13 |
| Rate for Payer: Aetna Commercial |
$4,980.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,759.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,549.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,597.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,766.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,656.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.94
|
| Rate for Payer: Cash Price |
$1,596.30
|
| Rate for Payer: Cigna Commercial |
$5,091.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,096.82
|
| Rate for Payer: Health EOS Commercial |
$4,925.12
|
| Rate for Payer: HFN Commercial |
$5,091.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,150.38
|
| Rate for Payer: Multiplan Commercial |
$4,427.07
|
| Rate for Payer: NAPHCARE Commercial |
$3,320.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,091.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.58
|
| Rate for Payer: Quartz Commercial |
$3,597.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,320.30
|
| Rate for Payer: The Alliance Commercial |
$2,766.92
|
| Rate for Payer: WEA Trust Commercial |
$3,043.61
|
| Rate for Payer: WPS Commercial |
$4,098.77
|
|
|
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 |
$2,711.58 |
| Max. Negotiated Rate |
$5,091.13 |
| Rate for Payer: Aetna Commercial |
$4,980.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,759.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.94
|
| Rate for Payer: Cash Price |
$1,596.30
|
| Rate for Payer: Cigna Commercial |
$5,091.13
|
| Rate for Payer: Health EOS Commercial |
$4,925.12
|
| Rate for Payer: HFN Commercial |
$5,091.13
|
| Rate for Payer: Multiplan Commercial |
$4,427.07
|
| Rate for Payer: Preferred Network Access Commercial |
$5,091.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.58
|
| Rate for Payer: Quartz Commercial |
$3,320.30
|
| Rate for Payer: WEA Trust Commercial |
$3,043.61
|
| Rate for Payer: WPS Commercial |
$4,098.77
|
|
|
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 |
$1,652.56 |
| Max. Negotiated Rate |
$5,429.84 |
| Rate for Payer: Aetna Commercial |
$5,311.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,075.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,652.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,836.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,951.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,832.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,128.06
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$5,429.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,302.85
|
| Rate for Payer: Health EOS Commercial |
$5,252.78
|
| Rate for Payer: HFN Commercial |
$5,429.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,426.50
|
| Rate for Payer: Multiplan Commercial |
$4,721.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,429.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.98
|
| Rate for Payer: Quartz Commercial |
$3,836.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,541.20
|
| Rate for Payer: The Alliance Commercial |
$2,951.00
|
| Rate for Payer: WEA Trust Commercial |
$3,246.10
|
| Rate for Payer: WPS Commercial |
$4,371.45
|
|
|
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 |
$2,891.98 |
| Max. Negotiated Rate |
$5,429.84 |
| Rate for Payer: Aetna Commercial |
$5,311.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,075.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,128.06
|
| Rate for Payer: Cash Price |
$1,702.50
|
| Rate for Payer: Cigna Commercial |
$5,429.84
|
| Rate for Payer: Health EOS Commercial |
$5,252.78
|
| Rate for Payer: HFN Commercial |
$5,429.84
|
| Rate for Payer: Multiplan Commercial |
$4,721.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,429.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.98
|
| Rate for Payer: Quartz Commercial |
$3,541.20
|
| Rate for Payer: WEA Trust Commercial |
$3,246.10
|
| Rate for Payer: WPS Commercial |
$4,371.45
|
|
|
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 |
$1,215.47 |
| Max. Negotiated Rate |
$3,993.68 |
| Rate for Payer: Aetna Commercial |
$3,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,733.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,215.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,821.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,170.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,083.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,300.71
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,993.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,429.27
|
| Rate for Payer: Health EOS Commercial |
$3,863.45
|
| Rate for Payer: HFN Commercial |
$3,993.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,255.72
|
| Rate for Payer: Multiplan Commercial |
$3,472.77
|
| Rate for Payer: NAPHCARE Commercial |
$2,604.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,993.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,127.07
|
| Rate for Payer: Quartz Commercial |
$2,821.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,604.58
|
| Rate for Payer: The Alliance Commercial |
$2,170.48
|
| Rate for Payer: WEA Trust Commercial |
$2,387.53
|
| Rate for Payer: WPS Commercial |
$3,215.23
|
|
|
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 |
$2,127.07 |
| Max. Negotiated Rate |
$3,993.68 |
| Rate for Payer: Aetna Commercial |
$3,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,733.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,300.71
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,993.68
|
| Rate for Payer: Health EOS Commercial |
$3,863.45
|
| Rate for Payer: HFN Commercial |
$3,993.68
|
| Rate for Payer: Multiplan Commercial |
$3,472.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,993.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,127.07
|
| Rate for Payer: Quartz Commercial |
$2,604.58
|
| Rate for Payer: WEA Trust Commercial |
$2,387.53
|
| Rate for Payer: WPS Commercial |
$3,215.23
|
|
|
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 |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
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 |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
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 |
$1,670.98 |
| Max. Negotiated Rate |
$3,137.35 |
| Rate for Payer: Aetna Commercial |
$3,069.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,807.38
|
| Rate for Payer: Cash Price |
$983.70
|
| Rate for Payer: Cigna Commercial |
$3,137.35
|
| Rate for Payer: Health EOS Commercial |
$3,035.04
|
| Rate for Payer: HFN Commercial |
$3,137.35
|
| Rate for Payer: Multiplan Commercial |
$2,728.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,137.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.98
|
| Rate for Payer: Quartz Commercial |
$2,046.10
|
| Rate for Payer: WEA Trust Commercial |
$1,875.59
|
| Rate for Payer: WPS Commercial |
$2,525.81
|
|
|
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 |
$954.84 |
| Max. Negotiated Rate |
$3,137.35 |
| Rate for Payer: Aetna Commercial |
$3,069.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,932.74
|
| Rate for Payer: Aetna Managed Medicare |
$954.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,216.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,705.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,636.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,807.38
|
| Rate for Payer: Cash Price |
$983.70
|
| Rate for Payer: Cigna Commercial |
$3,137.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,908.38
|
| Rate for Payer: Health EOS Commercial |
$3,035.04
|
| Rate for Payer: HFN Commercial |
$3,137.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,557.62
|
| Rate for Payer: Multiplan Commercial |
$2,728.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,046.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,137.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.98
|
| Rate for Payer: Quartz Commercial |
$2,216.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,046.10
|
| Rate for Payer: The Alliance Commercial |
$1,705.08
|
| Rate for Payer: WEA Trust Commercial |
$1,875.59
|
| Rate for Payer: WPS Commercial |
$2,525.81
|
|
|
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 |
$1,284.19 |
| Max. Negotiated Rate |
$4,219.49 |
| Rate for Payer: Aetna Commercial |
$4,127.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,430.79
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,219.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,566.62
|
| Rate for Payer: Health EOS Commercial |
$4,081.90
|
| Rate for Payer: HFN Commercial |
$4,219.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,439.80
|
| Rate for Payer: Multiplan Commercial |
$3,669.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,751.84
|
| Rate for Payer: Preferred Network Access Commercial |
$4,219.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.34
|
| Rate for Payer: Quartz Commercial |
$2,981.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,751.84
|
| Rate for Payer: The Alliance Commercial |
$2,293.20
|
| Rate for Payer: WEA Trust Commercial |
$2,522.52
|
| Rate for Payer: WPS Commercial |
$3,397.02
|
|
|
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 |
$2,247.34 |
| Max. Negotiated Rate |
$4,219.49 |
| Rate for Payer: Aetna Commercial |
$4,127.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,430.79
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,219.49
|
| Rate for Payer: Health EOS Commercial |
$4,081.90
|
| Rate for Payer: HFN Commercial |
$4,219.49
|
| Rate for Payer: Multiplan Commercial |
$3,669.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,219.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.34
|
| Rate for Payer: Quartz Commercial |
$2,751.84
|
| Rate for Payer: WEA Trust Commercial |
$2,522.52
|
| Rate for Payer: WPS Commercial |
$3,397.02
|
|
|
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 |
$1,179.94 |
| Max. Negotiated Rate |
$3,876.95 |
| Rate for Payer: Aetna Commercial |
$3,792.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,624.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,179.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,739.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,107.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,022.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,233.46
|
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cigna Commercial |
$3,876.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,358.26
|
| Rate for Payer: Health EOS Commercial |
$3,750.53
|
| Rate for Payer: HFN Commercial |
$3,876.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,160.56
|
| Rate for Payer: Multiplan Commercial |
$3,371.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,528.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,876.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,064.90
|
| Rate for Payer: Quartz Commercial |
$2,739.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,528.45
|
| Rate for Payer: The Alliance Commercial |
$2,107.04
|
| Rate for Payer: WEA Trust Commercial |
$2,317.74
|
| Rate for Payer: WPS Commercial |
$3,121.26
|
|
|
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 |
$2,064.90 |
| Max. Negotiated Rate |
$3,876.95 |
| Rate for Payer: Aetna Commercial |
$3,792.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,624.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,233.46
|
| Rate for Payer: Cash Price |
$1,215.60
|
| Rate for Payer: Cigna Commercial |
$3,876.95
|
| Rate for Payer: Health EOS Commercial |
$3,750.53
|
| Rate for Payer: HFN Commercial |
$3,876.95
|
| Rate for Payer: Multiplan Commercial |
$3,371.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,876.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,064.90
|
| Rate for Payer: Quartz Commercial |
$2,528.45
|
| Rate for Payer: WEA Trust Commercial |
$2,317.74
|
| Rate for Payer: WPS Commercial |
$3,121.26
|
|
