|
ANCHOR FIBERTAK SUTURE RC TRIPLOAD TAPE BL/W BLK/WW SELF-LOAD AR-3633SP
|
Facility
|
OP
|
$4,032.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.12 |
| 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: Aetna Managed Medicare |
$1,174.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,725.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,096.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,012.77
|
| 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: Dean Health DHI/DHP/ASO |
$2,346.62
|
| Rate for Payer: Health EOS Commercial |
$3,732.02
|
| Rate for Payer: HFN Commercial |
$3,857.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,144.96
|
| Rate for Payer: Multiplan Commercial |
$3,354.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,515.97
|
| 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 |
$2,725.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,515.97
|
| Rate for Payer: The Alliance Commercial |
$2,096.64
|
| Rate for Payer: WEA Trust Commercial |
$2,306.30
|
| Rate for Payer: WPS Commercial |
$3,105.85
|
|
|
ANCHOR GII QUICKANCHOR PLUS 212034
|
Facility
|
IP
|
$3,447.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.59 |
| Max. Negotiated Rate |
$3,298.09 |
| Rate for Payer: Aetna Commercial |
$3,226.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,083.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,899.99
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,298.09
|
| Rate for Payer: Health EOS Commercial |
$3,190.54
|
| Rate for Payer: HFN Commercial |
$3,298.09
|
| Rate for Payer: Multiplan Commercial |
$2,867.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,298.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,756.59
|
| Rate for Payer: Quartz Commercial |
$2,150.93
|
| Rate for Payer: WEA Trust Commercial |
$1,971.68
|
| Rate for Payer: WPS Commercial |
$2,655.22
|
|
|
ANCHOR GII QUICKANCHOR PLUS 212034
|
Facility
|
OP
|
$3,447.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.77 |
| Max. Negotiated Rate |
$3,298.09 |
| Rate for Payer: Aetna Commercial |
$3,226.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,083.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,003.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,330.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,792.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,720.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,899.99
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,298.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,006.15
|
| Rate for Payer: Health EOS Commercial |
$3,190.54
|
| Rate for Payer: HFN Commercial |
$3,298.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,688.66
|
| Rate for Payer: Multiplan Commercial |
$2,867.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,150.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,298.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,756.59
|
| Rate for Payer: Quartz Commercial |
$2,330.17
|
| Rate for Payer: Quartz Medicare Advantage |
$2,150.93
|
| Rate for Payer: The Alliance Commercial |
$1,792.44
|
| Rate for Payer: WEA Trust Commercial |
$1,971.68
|
| Rate for Payer: WPS Commercial |
$2,655.22
|
|
|
ANCHOR GII QUICKANCHOR WITH ORTHOCORD 222983
|
Facility
|
OP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.88 |
| Max. Negotiated Rate |
$5,710.18 |
| Rate for Payer: Aetna Commercial |
$5,586.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,337.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,034.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,103.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,979.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,289.56
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cigna Commercial |
$5,710.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,473.38
|
| Rate for Payer: Health EOS Commercial |
$5,523.98
|
| Rate for Payer: HFN Commercial |
$5,710.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,655.04
|
| Rate for Payer: Multiplan Commercial |
$4,965.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,724.03
|
| Rate for Payer: Preferred Network Access Commercial |
$5,710.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,041.29
|
| Rate for Payer: Quartz Commercial |
$4,034.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,724.03
|
| Rate for Payer: The Alliance Commercial |
$3,103.36
|
| Rate for Payer: WEA Trust Commercial |
$3,413.70
|
| Rate for Payer: WPS Commercial |
$4,597.15
|
|
|
ANCHOR GII QUICKANCHOR WITH ORTHOCORD 222983
|
Facility
|
IP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,041.29 |
| Max. Negotiated Rate |
$5,710.18 |
| Rate for Payer: Aetna Commercial |
$5,586.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,337.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,289.56
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cigna Commercial |
$5,710.18
|
| Rate for Payer: Health EOS Commercial |
$5,523.98
|
| Rate for Payer: HFN Commercial |
$5,710.18
|
| Rate for Payer: Multiplan Commercial |
$4,965.38
|
| Rate for Payer: Preferred Network Access Commercial |
$5,710.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,041.29
|
| Rate for Payer: Quartz Commercial |
$3,724.03
|
| Rate for Payer: WEA Trust Commercial |
$3,413.70
|
| Rate for Payer: WPS Commercial |
$4,597.15
|
|
|
ANCHOR JUGGERKNOT 2.9MM #2 BLUE MAXBRAID SINGLE 912029
|
Facility
|
OP
|
$4,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.96 |
| Max. Negotiated Rate |
$4,277.85 |
| Rate for Payer: Aetna Commercial |
$4,184.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,998.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,301.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,022.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,324.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,231.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.42
|
| Rate for Payer: Cash Price |
$1,341.30
|
| Rate for Payer: Cigna Commercial |
$4,277.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,602.12
|
| Rate for Payer: Health EOS Commercial |
$4,138.36
|
| Rate for Payer: HFN Commercial |
$4,277.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,487.38
|
| Rate for Payer: Multiplan Commercial |
$3,719.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,789.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,277.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.42
|
| Rate for Payer: Quartz Commercial |
$3,022.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,789.90
|
| Rate for Payer: The Alliance Commercial |
$2,324.92
|
| Rate for Payer: WEA Trust Commercial |
$2,557.41
|
| Rate for Payer: WPS Commercial |
$3,444.01
|
|
|
ANCHOR JUGGERKNOT 2.9MM #2 BLUE MAXBRAID SINGLE 912029
|
Facility
|
IP
|
$4,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.42 |
| Max. Negotiated Rate |
$4,277.85 |
| Rate for Payer: Aetna Commercial |
$4,184.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,998.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.42
|
| Rate for Payer: Cash Price |
$1,341.30
|
| Rate for Payer: Cigna Commercial |
$4,277.85
|
| Rate for Payer: Health EOS Commercial |
$4,138.36
|
| Rate for Payer: HFN Commercial |
$4,277.85
|
| Rate for Payer: Multiplan Commercial |
$3,719.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,277.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.42
|
| Rate for Payer: Quartz Commercial |
$2,789.90
|
| Rate for Payer: WEA Trust Commercial |
$2,557.41
|
| Rate for Payer: WPS Commercial |
$3,444.01
|
|
|
ANCHOR MICROFIX QUICKANCHOR 212855
|
Facility
|
IP
|
$4,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.70 |
| Max. Negotiated Rate |
$4,355.35 |
| Rate for Payer: Aetna Commercial |
$4,260.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,071.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,509.06
|
| Rate for Payer: Cash Price |
$1,365.60
|
| Rate for Payer: Cigna Commercial |
$4,355.35
|
| Rate for Payer: Health EOS Commercial |
$4,213.33
|
| Rate for Payer: HFN Commercial |
$4,355.35
|
| Rate for Payer: Multiplan Commercial |
$3,787.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,355.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,319.70
|
| Rate for Payer: Quartz Commercial |
$2,840.45
|
| Rate for Payer: WEA Trust Commercial |
$2,603.74
|
| Rate for Payer: WPS Commercial |
$3,506.41
|
|
|
ANCHOR MICROFIX QUICKANCHOR 212855
|
Facility
|
OP
|
$4,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,325.54 |
| Max. Negotiated Rate |
$4,355.35 |
| Rate for Payer: Aetna Commercial |
$4,260.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,071.31
|
| Rate for Payer: Aetna Managed Medicare |
$1,325.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,077.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,367.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,272.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,509.06
|
| Rate for Payer: Cash Price |
$1,365.60
|
| Rate for Payer: Cigna Commercial |
$4,355.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,649.26
|
| Rate for Payer: Health EOS Commercial |
$4,213.33
|
| Rate for Payer: HFN Commercial |
$4,355.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.56
|
| Rate for Payer: Multiplan Commercial |
$3,787.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,840.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,355.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,319.70
|
| Rate for Payer: Quartz Commercial |
$3,077.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,840.45
|
| Rate for Payer: The Alliance Commercial |
$2,367.04
|
| Rate for Payer: WEA Trust Commercial |
$2,603.74
|
| Rate for Payer: WPS Commercial |
$3,506.41
|
|
|
ANCHOR MINILOK QUICKANCHOR 2-0 212851
|
Facility
|
IP
|
$4,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.62 |
| Max. Negotiated Rate |
$4,097.97 |
| Rate for Payer: Aetna Commercial |
$4,008.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.79
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$4,097.97
|
| Rate for Payer: Health EOS Commercial |
$3,964.34
|
| Rate for Payer: HFN Commercial |
$4,097.97
|
| Rate for Payer: Multiplan Commercial |
$3,563.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.62
|
| Rate for Payer: Quartz Commercial |
$2,672.59
|
| Rate for Payer: WEA Trust Commercial |
$2,449.88
|
| Rate for Payer: WPS Commercial |
$3,299.19
|
|
|
ANCHOR MINILOK QUICKANCHOR 2-0 212851
|
Facility
|
OP
|
$4,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,247.21 |
| Max. Negotiated Rate |
$4,097.97 |
| Rate for Payer: Aetna Commercial |
$4,008.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,247.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,895.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,227.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,138.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.79
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$4,097.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.71
|
| Rate for Payer: Health EOS Commercial |
$3,964.34
|
| Rate for Payer: HFN Commercial |
$4,097.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,340.74
|
| Rate for Payer: Multiplan Commercial |
$3,563.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.62
|
| Rate for Payer: Quartz Commercial |
$2,895.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,672.59
|
| Rate for Payer: The Alliance Commercial |
$2,227.16
|
| Rate for Payer: WEA Trust Commercial |
$2,449.88
|
| Rate for Payer: WPS Commercial |
$3,299.19
|
|
|
ANCHOR MINI PUSHLOCK 2.5MM X 8MM BIO AR-8825B
|
Facility
|
IP
|
$3,799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,935.97 |
| Max. Negotiated Rate |
$3,634.88 |
| Rate for Payer: Aetna Commercial |
$3,555.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,397.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,094.01
|
| Rate for Payer: Cash Price |
$1,139.70
|
| Rate for Payer: Cigna Commercial |
$3,634.88
|
| Rate for Payer: Health EOS Commercial |
$3,516.35
|
| Rate for Payer: HFN Commercial |
$3,634.88
|
| Rate for Payer: Multiplan Commercial |
$3,160.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,634.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,935.97
|
| Rate for Payer: Quartz Commercial |
$2,370.58
|
| Rate for Payer: WEA Trust Commercial |
$2,173.03
|
| Rate for Payer: WPS Commercial |
$2,926.37
|
|
|
ANCHOR MINI PUSHLOCK 2.5MM X 8MM BIO AR-8825B
|
Facility
|
OP
|
$3,799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.27 |
| Max. Negotiated Rate |
$3,634.88 |
| Rate for Payer: Aetna Commercial |
$3,555.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,397.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,106.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,568.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,975.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,896.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,094.01
|
| Rate for Payer: Cash Price |
$1,139.70
|
| Rate for Payer: Cigna Commercial |
$3,634.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,211.02
|
| Rate for Payer: Health EOS Commercial |
$3,516.35
|
| Rate for Payer: HFN Commercial |
$3,634.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,963.22
|
| Rate for Payer: Multiplan Commercial |
$3,160.77
|
| Rate for Payer: NAPHCARE Commercial |
$2,370.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,634.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,935.97
|
| Rate for Payer: Quartz Commercial |
$2,568.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,370.58
|
| Rate for Payer: The Alliance Commercial |
$1,975.48
|
| Rate for Payer: WEA Trust Commercial |
$2,173.03
|
| Rate for Payer: WPS Commercial |
$2,926.37
|
|
|
ANCHOR MINI PUSHLOCK PEEK AR-8825P
|
Facility
|
IP
|
$3,799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,935.97 |
| Max. Negotiated Rate |
$3,634.88 |
| Rate for Payer: Aetna Commercial |
$3,555.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,397.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,094.01
|
| Rate for Payer: Cash Price |
$1,139.70
|
| Rate for Payer: Cigna Commercial |
$3,634.88
|
| Rate for Payer: Health EOS Commercial |
$3,516.35
|
| Rate for Payer: HFN Commercial |
$3,634.88
|
| Rate for Payer: Multiplan Commercial |
$3,160.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,634.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,935.97
|
| Rate for Payer: Quartz Commercial |
$2,370.58
|
| Rate for Payer: WEA Trust Commercial |
$2,173.03
|
| Rate for Payer: WPS Commercial |
$2,926.37
|
|
|
ANCHOR MINI PUSHLOCK PEEK AR-8825P
|
Facility
|
OP
|
$3,799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.27 |
| Max. Negotiated Rate |
$3,634.88 |
| Rate for Payer: Aetna Commercial |
$3,555.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,397.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,106.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,568.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,975.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,896.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,094.01
|
| Rate for Payer: Cash Price |
$1,139.70
|
| Rate for Payer: Cigna Commercial |
$3,634.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,211.02
|
| Rate for Payer: Health EOS Commercial |
$3,516.35
|
| Rate for Payer: HFN Commercial |
$3,634.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,963.22
|
| Rate for Payer: Multiplan Commercial |
$3,160.77
|
| Rate for Payer: NAPHCARE Commercial |
$2,370.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,634.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,935.97
|
| Rate for Payer: Quartz Commercial |
$2,568.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,370.58
|
| Rate for Payer: The Alliance Commercial |
$1,975.48
|
| Rate for Payer: WEA Trust Commercial |
$2,173.03
|
| Rate for Payer: WPS Commercial |
$2,926.37
|
|
|
ANCHOR PUSHLOCK 2.4MM HIP PEEK AR-2924PHS
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.26 |
| Max. Negotiated Rate |
$3,831.98 |
| Rate for Payer: Aetna Commercial |
$3,748.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,582.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,707.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,082.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,999.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,207.56
|
| Rate for Payer: Cash Price |
$1,201.50
|
| Rate for Payer: Cigna Commercial |
$3,831.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,330.91
|
| Rate for Payer: Health EOS Commercial |
$3,707.03
|
| Rate for Payer: HFN Commercial |
$3,831.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,123.90
|
| Rate for Payer: Multiplan Commercial |
$3,332.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,499.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,831.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,040.95
|
| Rate for Payer: Quartz Commercial |
$2,707.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,499.12
|
| Rate for Payer: The Alliance Commercial |
$2,082.60
|
| Rate for Payer: WEA Trust Commercial |
$2,290.86
|
| Rate for Payer: WPS Commercial |
$3,085.05
|
|
|
ANCHOR PUSHLOCK 2.4MM HIP PEEK AR-2924PHS
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.95 |
| Max. Negotiated Rate |
$3,831.98 |
| Rate for Payer: Aetna Commercial |
$3,748.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,582.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,207.56
|
| Rate for Payer: Cash Price |
$1,201.50
|
| Rate for Payer: Cigna Commercial |
$3,831.98
|
| Rate for Payer: Health EOS Commercial |
$3,707.03
|
| Rate for Payer: HFN Commercial |
$3,831.98
|
| Rate for Payer: Multiplan Commercial |
$3,332.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,831.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,040.95
|
| Rate for Payer: Quartz Commercial |
$2,499.12
|
| Rate for Payer: WEA Trust Commercial |
$2,290.86
|
| Rate for Payer: WPS Commercial |
$3,085.05
|
|
|
ANCHOR PUSHLOCK 2.9MM AR-1923BC
|
Facility
|
OP
|
$4,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.26 |
| Max. Negotiated Rate |
$4,755.30 |
| Rate for Payer: Aetna Commercial |
$4,651.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,445.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,447.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,359.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,584.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,481.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,739.46
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$4,755.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,892.54
|
| Rate for Payer: Health EOS Commercial |
$4,600.23
|
| Rate for Payer: HFN Commercial |
$4,755.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,876.60
|
| Rate for Payer: Multiplan Commercial |
$4,135.04
|
| Rate for Payer: NAPHCARE Commercial |
$3,101.28
|
| Rate for Payer: Preferred Network Access Commercial |
$4,755.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,532.71
|
| Rate for Payer: Quartz Commercial |
$3,359.72
|
| Rate for Payer: Quartz Medicare Advantage |
$3,101.28
|
| Rate for Payer: The Alliance Commercial |
$2,584.40
|
| Rate for Payer: WEA Trust Commercial |
$2,842.84
|
| Rate for Payer: WPS Commercial |
$3,828.39
|
|
|
ANCHOR PUSHLOCK 2.9MM AR-1923BC
|
Facility
|
IP
|
$4,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,532.71 |
| Max. Negotiated Rate |
$4,755.30 |
| Rate for Payer: Aetna Commercial |
$4,651.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,445.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,739.46
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$4,755.30
|
| Rate for Payer: Health EOS Commercial |
$4,600.23
|
| Rate for Payer: HFN Commercial |
$4,755.30
|
| Rate for Payer: Multiplan Commercial |
$4,135.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,755.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,532.71
|
| Rate for Payer: Quartz Commercial |
$3,101.28
|
| Rate for Payer: WEA Trust Commercial |
$2,842.84
|
| Rate for Payer: WPS Commercial |
$3,828.39
|
|
|
ANCHOR PUSHLOCK 2.9MMSHORT AR-2923BC
|
Facility
|
IP
|
$3,934.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.77 |
| Max. Negotiated Rate |
$3,764.05 |
| Rate for Payer: Aetna Commercial |
$3,682.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.42
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cigna Commercial |
$3,764.05
|
| Rate for Payer: Health EOS Commercial |
$3,641.31
|
| Rate for Payer: HFN Commercial |
$3,764.05
|
| Rate for Payer: Multiplan Commercial |
$3,273.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,764.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.77
|
| Rate for Payer: Quartz Commercial |
$2,454.82
|
| Rate for Payer: WEA Trust Commercial |
$2,250.25
|
| Rate for Payer: WPS Commercial |
$3,030.36
|
|
|
ANCHOR PUSHLOCK 2.9MMSHORT AR-2923BC
|
Facility
|
OP
|
$3,934.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.58 |
| Max. Negotiated Rate |
$3,764.05 |
| Rate for Payer: Aetna Commercial |
$3,682.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,659.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,045.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,963.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.42
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cigna Commercial |
$3,764.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,289.59
|
| Rate for Payer: Health EOS Commercial |
$3,641.31
|
| Rate for Payer: HFN Commercial |
$3,764.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.52
|
| Rate for Payer: Multiplan Commercial |
$3,273.09
|
| Rate for Payer: NAPHCARE Commercial |
$2,454.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,764.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.77
|
| Rate for Payer: Quartz Commercial |
$2,659.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,454.82
|
| Rate for Payer: The Alliance Commercial |
$2,045.68
|
| Rate for Payer: WEA Trust Commercial |
$2,250.25
|
| Rate for Payer: WPS Commercial |
$3,030.36
|
|
|
ANCHOR PUSHLOCK 3.5MM BIO AR-1926B
|
Facility
|
IP
|
$4,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.93 |
| Max. Negotiated Rate |
$4,278.81 |
| Rate for Payer: Aetna Commercial |
$4,185.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,999.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.97
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cigna Commercial |
$4,278.81
|
| Rate for Payer: Health EOS Commercial |
$4,139.28
|
| Rate for Payer: HFN Commercial |
$4,278.81
|
| Rate for Payer: Multiplan Commercial |
$3,720.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,278.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.93
|
| Rate for Payer: Quartz Commercial |
$2,790.53
|
| Rate for Payer: WEA Trust Commercial |
$2,557.98
|
| Rate for Payer: WPS Commercial |
$3,444.78
|
|
|
ANCHOR PUSHLOCK 3.5MM BIO AR-1926B
|
Facility
|
OP
|
$4,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.25 |
| Max. Negotiated Rate |
$4,278.81 |
| Rate for Payer: Aetna Commercial |
$4,185.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,999.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,023.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,325.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,232.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,464.97
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cigna Commercial |
$4,278.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,602.70
|
| Rate for Payer: Health EOS Commercial |
$4,139.28
|
| Rate for Payer: HFN Commercial |
$4,278.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,488.16
|
| Rate for Payer: Multiplan Commercial |
$3,720.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,790.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,278.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,278.93
|
| Rate for Payer: Quartz Commercial |
$3,023.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,790.53
|
| Rate for Payer: The Alliance Commercial |
$2,325.44
|
| Rate for Payer: WEA Trust Commercial |
$2,557.98
|
| Rate for Payer: WPS Commercial |
$3,444.78
|
|
|
ANCHOR PUSHLOCK 3.5MM BIO SELF-PUNCHING AR-1926BCSP
|
Facility
|
IP
|
$4,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.40 |
| Max. Negotiated Rate |
$4,275.94 |
| Rate for Payer: Aetna Commercial |
$4,182.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,997.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,463.31
|
| Rate for Payer: Cash Price |
$1,340.70
|
| Rate for Payer: Cigna Commercial |
$4,275.94
|
| Rate for Payer: Health EOS Commercial |
$4,136.51
|
| Rate for Payer: HFN Commercial |
$4,275.94
|
| Rate for Payer: Multiplan Commercial |
$3,718.21
|
| Rate for Payer: Preferred Network Access Commercial |
$4,275.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,277.40
|
| Rate for Payer: Quartz Commercial |
$2,788.66
|
| Rate for Payer: WEA Trust Commercial |
$2,556.27
|
| Rate for Payer: WPS Commercial |
$3,442.47
|
|
|
ANCHOR PUSHLOCK 3.5MM BIO SELF-PUNCHING AR-1926BCSP
|
Facility
|
OP
|
$4,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.37 |
| Max. Negotiated Rate |
$4,275.94 |
| Rate for Payer: Aetna Commercial |
$4,182.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,997.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,301.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,021.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,323.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,230.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,463.31
|
| Rate for Payer: Cash Price |
$1,340.70
|
| Rate for Payer: Cigna Commercial |
$4,275.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,600.96
|
| Rate for Payer: Health EOS Commercial |
$4,136.51
|
| Rate for Payer: HFN Commercial |
$4,275.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,485.82
|
| Rate for Payer: Multiplan Commercial |
$3,718.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,788.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,275.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,277.40
|
| Rate for Payer: Quartz Commercial |
$3,021.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,788.66
|
| Rate for Payer: The Alliance Commercial |
$2,323.88
|
| Rate for Payer: WEA Trust Commercial |
$2,556.27
|
| Rate for Payer: WPS Commercial |
$3,442.47
|
|
