|
ANCHOR 6.5 BIO-CORK AR-1925BF
|
Facility
|
IP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.81 |
| 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 6.5 BIO-CORK AR-1925BF
|
Facility
|
OP
|
$3,157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 BIO-SUTURETAK KNOTLESS AR-1938BC
|
Facility
|
IP
|
$4,663.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.26 |
| Max. Negotiated Rate |
$4,461.56 |
| Rate for Payer: Aetna Commercial |
$4,364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,170.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.25
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,461.56
|
| Rate for Payer: Health EOS Commercial |
$4,316.07
|
| Rate for Payer: HFN Commercial |
$4,461.56
|
| Rate for Payer: Multiplan Commercial |
$3,879.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,461.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.26
|
| Rate for Payer: Quartz Commercial |
$2,909.71
|
| Rate for Payer: WEA Trust Commercial |
$2,667.24
|
| Rate for Payer: WPS Commercial |
$3,591.91
|
|
|
ANCHOR BIO-SUTURETAK KNOTLESS AR-1938BC
|
Facility
|
OP
|
$4,663.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,357.87 |
| Max. Negotiated Rate |
$4,461.56 |
| Rate for Payer: Aetna Commercial |
$4,364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,170.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,357.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,152.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,424.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,327.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.25
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,461.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,713.87
|
| Rate for Payer: Health EOS Commercial |
$4,316.07
|
| Rate for Payer: HFN Commercial |
$4,461.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,637.14
|
| Rate for Payer: Multiplan Commercial |
$3,879.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,909.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,461.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.26
|
| Rate for Payer: Quartz Commercial |
$3,152.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,909.71
|
| Rate for Payer: The Alliance Commercial |
$2,424.76
|
| Rate for Payer: WEA Trust Commercial |
$2,667.24
|
| Rate for Payer: WPS Commercial |
$3,591.91
|
|
|
ANCHOR BIO-SWIVELOCK SUTURE
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,143.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,321.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,706.30
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,627.00
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$3,143.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,901.60
|
| Rate for Payer: The Alliance Commercial |
$2,418.00
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,581.89
|
|
|
ANCHOR BIO-SWIVELOCK SUTURE
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.64 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,581.89
|
|
|
ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP TIGER TAPE ((WHITE/BLACK) AR-3653SP
|
Facility
|
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6212989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.39 |
| Max. Negotiated Rate |
$3,776.49 |
| Rate for Payer: Aetna Commercial |
$3,694.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,530.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,175.59
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,776.49
|
| Rate for Payer: Health EOS Commercial |
$3,653.34
|
| Rate for Payer: HFN Commercial |
$3,776.49
|
| Rate for Payer: Multiplan Commercial |
$3,283.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,776.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.39
|
| Rate for Payer: Quartz Commercial |
$2,462.93
|
| Rate for Payer: WEA Trust Commercial |
$2,257.68
|
| Rate for Payer: WPS Commercial |
$3,040.37
|
|
|
ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP TIGER TAPE ((WHITE/BLACK) AR-3653SP
|
Facility
|
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6212989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.37 |
| Max. Negotiated Rate |
$3,776.49 |
| Rate for Payer: Aetna Commercial |
$3,694.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,530.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,668.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,052.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,970.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,175.59
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,776.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,297.15
|
| Rate for Payer: Health EOS Commercial |
$3,653.34
|
| Rate for Payer: HFN Commercial |
$3,776.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,078.66
|
| Rate for Payer: Multiplan Commercial |
$3,283.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,462.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,776.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.39
|
| Rate for Payer: Quartz Commercial |
$2,668.17
|
| Rate for Payer: Quartz Medicare Advantage |
$2,462.93
|
| Rate for Payer: The Alliance Commercial |
$2,052.44
|
| Rate for Payer: WEA Trust Commercial |
$2,257.68
|
| Rate for Payer: WPS Commercial |
$3,040.37
|
|
|
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 |
$1,229.45 |
| Max. Negotiated Rate |
$4,039.61 |
| Rate for Payer: Aetna Commercial |
$3,951.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,776.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,229.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,854.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,195.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,107.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,327.17
|
| Rate for Payer: Cash Price |
$1,266.60
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,457.20
|
| Rate for Payer: Health EOS Commercial |
$3,907.88
|
| Rate for Payer: HFN Commercial |
$4,039.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,293.16
|
| Rate for Payer: Multiplan Commercial |
$3,512.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,634.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,039.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,151.53
|
| Rate for Payer: Quartz Commercial |
$2,854.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,634.53
|
| Rate for Payer: The Alliance Commercial |
$2,195.44
|
| Rate for Payer: WEA Trust Commercial |
$2,414.98
|
| Rate for Payer: WPS Commercial |
$3,252.21
|
|
|
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 |
$2,151.53 |
| Max. Negotiated Rate |
$4,039.61 |
| Rate for Payer: Aetna Commercial |
$3,951.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,776.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,327.17
|
| Rate for Payer: Cash Price |
$1,266.60
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: Health EOS Commercial |
$3,907.88
|
| Rate for Payer: HFN Commercial |
$4,039.61
|
| Rate for Payer: Multiplan Commercial |
$3,512.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,039.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,151.53
|
| Rate for Payer: Quartz Commercial |
$2,634.53
|
| Rate for Payer: WEA Trust Commercial |
$2,414.98
|
| Rate for Payer: WPS Commercial |
$3,252.21
|
|
|
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 |
$2,345.69 |
| Max. Negotiated Rate |
$4,404.15 |
| Rate for Payer: Aetna Commercial |
$4,308.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.17
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,404.15
|
| Rate for Payer: Health EOS Commercial |
$4,260.54
|
| Rate for Payer: HFN Commercial |
$4,404.15
|
| Rate for Payer: Multiplan Commercial |
$3,829.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.69
|
| Rate for Payer: Quartz Commercial |
$2,872.27
|
| Rate for Payer: WEA Trust Commercial |
$2,632.92
|
| Rate for Payer: WPS Commercial |
$3,545.69
|
|
|
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 |
$1,340.39 |
| Max. Negotiated Rate |
$4,404.15 |
| Rate for Payer: Aetna Commercial |
$4,308.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.17
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,404.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.95
|
| Rate for Payer: Health EOS Commercial |
$4,260.54
|
| Rate for Payer: HFN Commercial |
$4,404.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.34
|
| Rate for Payer: Multiplan Commercial |
$3,829.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.69
|
| Rate for Payer: Quartz Commercial |
$3,111.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.27
|
| Rate for Payer: The Alliance Commercial |
$2,393.56
|
| Rate for Payer: WEA Trust Commercial |
$2,632.92
|
| Rate for Payer: WPS Commercial |
$3,545.69
|
|
|
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 |
$1,651.40 |
| Max. Negotiated Rate |
$5,426.01 |
| Rate for Payer: Aetna Commercial |
$5,308.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,072.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,651.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,833.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,948.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,830.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,125.86
|
| Rate for Payer: Cash Price |
$1,701.30
|
| Rate for Payer: Cigna Commercial |
$5,426.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,300.52
|
| Rate for Payer: Health EOS Commercial |
$5,249.08
|
| Rate for Payer: HFN Commercial |
$5,426.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,423.38
|
| Rate for Payer: Multiplan Commercial |
$4,718.27
|
| Rate for Payer: NAPHCARE Commercial |
$3,538.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,426.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,889.94
|
| Rate for Payer: Quartz Commercial |
$3,833.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,538.70
|
| Rate for Payer: The Alliance Commercial |
$2,948.92
|
| Rate for Payer: WEA Trust Commercial |
$3,243.81
|
| Rate for Payer: WPS Commercial |
$4,368.37
|
|
|
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 |
$2,889.94 |
| Max. Negotiated Rate |
$5,426.01 |
| Rate for Payer: Aetna Commercial |
$5,308.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,072.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,125.86
|
| Rate for Payer: Cash Price |
$1,701.30
|
| Rate for Payer: Cigna Commercial |
$5,426.01
|
| Rate for Payer: Health EOS Commercial |
$5,249.08
|
| Rate for Payer: HFN Commercial |
$5,426.01
|
| Rate for Payer: Multiplan Commercial |
$4,718.27
|
| Rate for Payer: Preferred Network Access Commercial |
$5,426.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,889.94
|
| Rate for Payer: Quartz Commercial |
$3,538.70
|
| Rate for Payer: WEA Trust Commercial |
$3,243.81
|
| Rate for Payer: WPS Commercial |
$4,368.37
|
|
|
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 |
$936.79 |
| Max. Negotiated Rate |
$3,078.03 |
| Rate for Payer: Aetna Commercial |
$3,011.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,877.28
|
| Rate for Payer: Aetna Managed Medicare |
$936.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,174.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,672.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,605.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,773.21
|
| Rate for Payer: Cash Price |
$965.10
|
| Rate for Payer: Cigna Commercial |
$3,078.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,872.29
|
| Rate for Payer: Health EOS Commercial |
$2,977.66
|
| Rate for Payer: HFN Commercial |
$3,078.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,509.26
|
| Rate for Payer: Multiplan Commercial |
$2,676.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,007.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,078.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,639.38
|
| Rate for Payer: Quartz Commercial |
$2,174.69
|
| Rate for Payer: Quartz Medicare Advantage |
$2,007.41
|
| Rate for Payer: The Alliance Commercial |
$1,672.84
|
| Rate for Payer: WEA Trust Commercial |
$1,840.12
|
| Rate for Payer: WPS Commercial |
$2,478.06
|
|
|
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 |
$1,639.38 |
| Max. Negotiated Rate |
$3,078.03 |
| Rate for Payer: Aetna Commercial |
$3,011.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,877.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,773.21
|
| Rate for Payer: Cash Price |
$965.10
|
| Rate for Payer: Cigna Commercial |
$3,078.03
|
| Rate for Payer: Health EOS Commercial |
$2,977.66
|
| Rate for Payer: HFN Commercial |
$3,078.03
|
| Rate for Payer: Multiplan Commercial |
$2,676.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,078.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,639.38
|
| Rate for Payer: Quartz Commercial |
$2,007.41
|
| Rate for Payer: WEA Trust Commercial |
$1,840.12
|
| Rate for Payer: WPS Commercial |
$2,478.06
|
|
|
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 |
$1,545.11 |
| Max. Negotiated Rate |
$5,076.78 |
| Rate for Payer: Aetna Commercial |
$4,966.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,745.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,545.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,586.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,759.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,648.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,924.67
|
| Rate for Payer: Cash Price |
$1,591.80
|
| Rate for Payer: Cigna Commercial |
$5,076.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,088.09
|
| Rate for Payer: Health EOS Commercial |
$4,911.23
|
| Rate for Payer: HFN Commercial |
$5,076.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,138.68
|
| Rate for Payer: Multiplan Commercial |
$4,414.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,310.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,076.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,703.94
|
| Rate for Payer: Quartz Commercial |
$3,586.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,310.94
|
| Rate for Payer: The Alliance Commercial |
$2,759.12
|
| Rate for Payer: WEA Trust Commercial |
$3,035.03
|
| Rate for Payer: WPS Commercial |
$4,087.21
|
|
|
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 |
$2,703.94 |
| Max. Negotiated Rate |
$5,076.78 |
| Rate for Payer: Aetna Commercial |
$4,966.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,745.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,924.67
|
| Rate for Payer: Cash Price |
$1,591.80
|
| Rate for Payer: Cigna Commercial |
$5,076.78
|
| Rate for Payer: Health EOS Commercial |
$4,911.23
|
| Rate for Payer: HFN Commercial |
$5,076.78
|
| Rate for Payer: Multiplan Commercial |
$4,414.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,076.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,703.94
|
| Rate for Payer: Quartz Commercial |
$3,310.94
|
| Rate for Payer: WEA Trust Commercial |
$3,035.03
|
| Rate for Payer: WPS Commercial |
$4,087.21
|
|
|
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 |
$2,105.16 |
| Max. Negotiated Rate |
$3,952.54 |
| Rate for Payer: Aetna Commercial |
$3,866.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,694.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.01
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna Commercial |
$3,952.54
|
| Rate for Payer: Health EOS Commercial |
$3,823.65
|
| Rate for Payer: HFN Commercial |
$3,952.54
|
| Rate for Payer: Multiplan Commercial |
$3,436.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,952.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.16
|
| Rate for Payer: Quartz Commercial |
$2,577.74
|
| Rate for Payer: WEA Trust Commercial |
$2,362.93
|
| Rate for Payer: WPS Commercial |
$3,182.11
|
|
|
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 |
$1,202.95 |
| Max. Negotiated Rate |
$3,952.54 |
| Rate for Payer: Aetna Commercial |
$3,866.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,694.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,202.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,792.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,148.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,062.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.01
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna Commercial |
$3,952.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,404.24
|
| Rate for Payer: Health EOS Commercial |
$3,823.65
|
| Rate for Payer: HFN Commercial |
$3,952.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,222.18
|
| Rate for Payer: Multiplan Commercial |
$3,436.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,577.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,952.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.16
|
| Rate for Payer: Quartz Commercial |
$2,792.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,577.74
|
| Rate for Payer: The Alliance Commercial |
$2,148.12
|
| Rate for Payer: WEA Trust Commercial |
$2,362.93
|
| Rate for Payer: WPS Commercial |
$3,182.11
|
|
|
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 |
$1,405.33 |
| Max. Negotiated Rate |
$4,617.52 |
| Rate for Payer: Aetna Commercial |
$4,517.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,316.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,405.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,262.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,509.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,409.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,660.09
|
| Rate for Payer: Cash Price |
$1,447.80
|
| Rate for Payer: Cigna Commercial |
$4,617.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,808.73
|
| Rate for Payer: Health EOS Commercial |
$4,466.95
|
| Rate for Payer: HFN Commercial |
$4,617.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,764.28
|
| Rate for Payer: Multiplan Commercial |
$4,015.23
|
| Rate for Payer: NAPHCARE Commercial |
$3,011.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,617.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,459.33
|
| Rate for Payer: Quartz Commercial |
$3,262.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,011.42
|
| Rate for Payer: The Alliance Commercial |
$2,509.52
|
| Rate for Payer: WEA Trust Commercial |
$2,760.47
|
| Rate for Payer: WPS Commercial |
$3,717.47
|
|
|
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 |
$2,459.33 |
| Max. Negotiated Rate |
$4,617.52 |
| Rate for Payer: Aetna Commercial |
$4,517.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,316.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,660.09
|
| Rate for Payer: Cash Price |
$1,447.80
|
| Rate for Payer: Cigna Commercial |
$4,617.52
|
| Rate for Payer: Health EOS Commercial |
$4,466.95
|
| Rate for Payer: HFN Commercial |
$4,617.52
|
| Rate for Payer: Multiplan Commercial |
$4,015.23
|
| Rate for Payer: Preferred Network Access Commercial |
$4,617.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,459.33
|
| Rate for Payer: Quartz Commercial |
$3,011.42
|
| Rate for Payer: WEA Trust Commercial |
$2,760.47
|
| Rate for Payer: WPS Commercial |
$3,717.47
|
|
|
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 |
$371.57 |
| Max. Negotiated Rate |
$1,220.88 |
| Rate for Payer: Aetna Commercial |
$1,194.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Aetna Managed Medicare |
$371.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$862.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.33
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.63
|
| Rate for Payer: Health EOS Commercial |
$1,181.07
|
| Rate for Payer: HFN Commercial |
$1,220.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$995.28
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: NAPHCARE Commercial |
$796.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$650.25
|
| Rate for Payer: Quartz Commercial |
$862.58
|
| Rate for Payer: Quartz Medicare Advantage |
$796.22
|
| Rate for Payer: The Alliance Commercial |
$663.52
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$982.90
|
|
|
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 |
$650.25 |
| Max. Negotiated Rate |
$1,220.88 |
| Rate for Payer: Aetna Commercial |
$1,194.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.33
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,220.88
|
| Rate for Payer: Health EOS Commercial |
$1,181.07
|
| Rate for Payer: HFN Commercial |
$1,220.88
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$650.25
|
| Rate for Payer: Quartz Commercial |
$796.22
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$982.90
|
|
|
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 |
$2,054.71 |
| Max. Negotiated Rate |
$3,857.82 |
| Rate for Payer: Aetna Commercial |
$3,773.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,606.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,222.44
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cigna Commercial |
$3,857.82
|
| Rate for Payer: Health EOS Commercial |
$3,732.02
|
| Rate for Payer: HFN Commercial |
$3,857.82
|
| Rate for Payer: Multiplan Commercial |
$3,354.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,857.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,054.71
|
| Rate for Payer: Quartz Commercial |
$2,515.97
|
| Rate for Payer: WEA Trust Commercial |
$2,306.30
|
| Rate for Payer: WPS Commercial |
$3,105.85
|
|
