|
STAPEDECTOMY
|
Facility
|
OP
|
$7,602.00
|
|
| Hospital Charge Code |
2960387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,213.70 |
| Max. Negotiated Rate |
$7,273.59 |
| Rate for Payer: Aetna Commercial |
$7,115.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,799.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,213.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,138.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,953.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,794.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,190.22
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$7,273.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,424.36
|
| Rate for Payer: Health EOS Commercial |
$7,036.41
|
| Rate for Payer: HFN Commercial |
$7,273.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,929.56
|
| Rate for Payer: Multiplan Commercial |
$6,324.86
|
| Rate for Payer: NAPHCARE Commercial |
$4,743.65
|
| Rate for Payer: Preferred Network Access Commercial |
$7,273.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,873.98
|
| Rate for Payer: Quartz Commercial |
$5,138.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,743.65
|
| Rate for Payer: The Alliance Commercial |
$3,953.04
|
| Rate for Payer: WEA Trust Commercial |
$4,348.34
|
| Rate for Payer: WPS Commercial |
$5,855.82
|
|
|
STAPEDECTOMY
|
Facility
|
IP
|
$7,602.00
|
|
| Hospital Charge Code |
2960387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,873.98 |
| Max. Negotiated Rate |
$7,273.59 |
| Rate for Payer: Aetna Commercial |
$7,115.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,799.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,190.22
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$7,273.59
|
| Rate for Payer: Health EOS Commercial |
$7,036.41
|
| Rate for Payer: HFN Commercial |
$7,273.59
|
| Rate for Payer: Multiplan Commercial |
$6,324.86
|
| Rate for Payer: Preferred Network Access Commercial |
$7,273.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,873.98
|
| Rate for Payer: Quartz Commercial |
$4,743.65
|
| Rate for Payer: WEA Trust Commercial |
$4,348.34
|
| Rate for Payer: WPS Commercial |
$5,855.82
|
|
|
STAPER RELOAD 80-3.8 GIA8038L
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2962915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
STAPER RELOAD 80-3.8 GIA8038L
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2962915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
STAPLE DYNANITE NITI 15WX15L AR-8719DS-1515
|
Facility
|
IP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,762.90 |
| Max. Negotiated Rate |
$12,697.69 |
| Rate for Payer: Aetna Commercial |
$12,421.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,869.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,314.98
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,697.69
|
| Rate for Payer: Health EOS Commercial |
$12,283.64
|
| Rate for Payer: HFN Commercial |
$12,697.69
|
| Rate for Payer: Multiplan Commercial |
$11,041.47
|
| Rate for Payer: Preferred Network Access Commercial |
$12,697.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,762.90
|
| Rate for Payer: Quartz Commercial |
$8,281.10
|
| Rate for Payer: WEA Trust Commercial |
$7,591.01
|
| Rate for Payer: WPS Commercial |
$10,222.65
|
|
|
STAPLE DYNANITE NITI 15WX15L AR-8719DS-1515
|
Facility
|
OP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,864.52 |
| Max. Negotiated Rate |
$12,697.69 |
| Rate for Payer: Aetna Commercial |
$12,421.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,869.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,864.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,971.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,900.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,624.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,314.98
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,697.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,723.72
|
| Rate for Payer: Health EOS Commercial |
$12,283.64
|
| Rate for Payer: HFN Commercial |
$12,697.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,351.38
|
| Rate for Payer: Multiplan Commercial |
$11,041.47
|
| Rate for Payer: NAPHCARE Commercial |
$8,281.10
|
| Rate for Payer: Preferred Network Access Commercial |
$12,697.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,762.90
|
| Rate for Payer: Quartz Commercial |
$8,971.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8,281.10
|
| Rate for Payer: The Alliance Commercial |
$6,900.92
|
| Rate for Payer: WEA Trust Commercial |
$7,591.01
|
| Rate for Payer: WPS Commercial |
$10,222.65
|
|
|
STAPLE DYNANITE SUPERMX 18WX15L AR-8719MXDS-1815
|
Facility
|
OP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,864.52 |
| Max. Negotiated Rate |
$12,697.69 |
| Rate for Payer: Aetna Commercial |
$12,421.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,869.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,864.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,971.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,900.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,624.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,314.98
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,697.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,723.72
|
| Rate for Payer: Health EOS Commercial |
$12,283.64
|
| Rate for Payer: HFN Commercial |
$12,697.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,351.38
|
| Rate for Payer: Multiplan Commercial |
$11,041.47
|
| Rate for Payer: NAPHCARE Commercial |
$8,281.10
|
| Rate for Payer: Preferred Network Access Commercial |
$12,697.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,762.90
|
| Rate for Payer: Quartz Commercial |
$8,971.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8,281.10
|
| Rate for Payer: The Alliance Commercial |
$6,900.92
|
| Rate for Payer: WEA Trust Commercial |
$7,591.01
|
| Rate for Payer: WPS Commercial |
$10,222.65
|
|
|
STAPLE DYNANITE SUPERMX 18WX15L AR-8719MXDS-1815
|
Facility
|
IP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,762.90 |
| Max. Negotiated Rate |
$12,697.69 |
| Rate for Payer: Aetna Commercial |
$12,421.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,869.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,314.98
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,697.69
|
| Rate for Payer: Health EOS Commercial |
$12,283.64
|
| Rate for Payer: HFN Commercial |
$12,697.69
|
| Rate for Payer: Multiplan Commercial |
$11,041.47
|
| Rate for Payer: Preferred Network Access Commercial |
$12,697.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,762.90
|
| Rate for Payer: Quartz Commercial |
$8,281.10
|
| Rate for Payer: WEA Trust Commercial |
$7,591.01
|
| Rate for Payer: WPS Commercial |
$10,222.65
|
|
|
STAPLE DYNANITE SUPERMX 20WX20L AR-8719MXDS-2020
|
Facility
|
IP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,762.90 |
| Max. Negotiated Rate |
$12,697.69 |
| Rate for Payer: Aetna Commercial |
$12,421.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,869.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,314.98
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,697.69
|
| Rate for Payer: Health EOS Commercial |
$12,283.64
|
| Rate for Payer: HFN Commercial |
$12,697.69
|
| Rate for Payer: Multiplan Commercial |
$11,041.47
|
| Rate for Payer: Preferred Network Access Commercial |
$12,697.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,762.90
|
| Rate for Payer: Quartz Commercial |
$8,281.10
|
| Rate for Payer: WEA Trust Commercial |
$7,591.01
|
| Rate for Payer: WPS Commercial |
$10,222.65
|
|
|
STAPLE DYNANITE SUPERMX 20WX20L AR-8719MXDS-2020
|
Facility
|
OP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,864.52 |
| Max. Negotiated Rate |
$12,697.69 |
| Rate for Payer: Aetna Commercial |
$12,421.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,869.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,864.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,971.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,900.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,624.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,314.98
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,697.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,723.72
|
| Rate for Payer: Health EOS Commercial |
$12,283.64
|
| Rate for Payer: HFN Commercial |
$12,697.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,351.38
|
| Rate for Payer: Multiplan Commercial |
$11,041.47
|
| Rate for Payer: NAPHCARE Commercial |
$8,281.10
|
| Rate for Payer: Preferred Network Access Commercial |
$12,697.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,762.90
|
| Rate for Payer: Quartz Commercial |
$8,971.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8,281.10
|
| Rate for Payer: The Alliance Commercial |
$6,900.92
|
| Rate for Payer: WEA Trust Commercial |
$7,591.01
|
| Rate for Payer: WPS Commercial |
$10,222.65
|
|
|
STAPLE EASYFUSE 15 X 15 NITINOL 2-LEG FFS21515
|
Facility
|
IP
|
$7,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,915.77 |
| Max. Negotiated Rate |
$7,352.05 |
| Rate for Payer: Aetna Commercial |
$7,192.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,872.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,235.42
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,352.05
|
| Rate for Payer: Health EOS Commercial |
$7,112.31
|
| Rate for Payer: HFN Commercial |
$7,352.05
|
| Rate for Payer: Multiplan Commercial |
$6,393.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,352.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,915.77
|
| Rate for Payer: Quartz Commercial |
$4,794.82
|
| Rate for Payer: WEA Trust Commercial |
$4,395.25
|
| Rate for Payer: WPS Commercial |
$5,918.99
|
|
|
STAPLE EASYFUSE 15 X 15 NITINOL 2-LEG FFS21515
|
Facility
|
OP
|
$7,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,237.58 |
| Max. Negotiated Rate |
$7,352.05 |
| Rate for Payer: Aetna Commercial |
$7,192.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,872.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,237.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,194.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,995.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,835.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,235.42
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,352.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,472.09
|
| Rate for Payer: Health EOS Commercial |
$7,112.31
|
| Rate for Payer: HFN Commercial |
$7,352.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,993.52
|
| Rate for Payer: Multiplan Commercial |
$6,393.09
|
| Rate for Payer: NAPHCARE Commercial |
$4,794.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,352.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,915.77
|
| Rate for Payer: Quartz Commercial |
$5,194.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,794.82
|
| Rate for Payer: The Alliance Commercial |
$3,995.68
|
| Rate for Payer: WEA Trust Commercial |
$4,395.25
|
| Rate for Payer: WPS Commercial |
$5,918.99
|
|
|
STAPLE EASYFUSE 18 X 15 NITINOL 2-LEG FFS21815
|
Facility
|
OP
|
$7,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,237.58 |
| Max. Negotiated Rate |
$7,352.05 |
| Rate for Payer: Aetna Commercial |
$7,192.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,872.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,237.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,194.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,995.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,835.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,235.42
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,352.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,472.09
|
| Rate for Payer: Health EOS Commercial |
$7,112.31
|
| Rate for Payer: HFN Commercial |
$7,352.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,993.52
|
| Rate for Payer: Multiplan Commercial |
$6,393.09
|
| Rate for Payer: NAPHCARE Commercial |
$4,794.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,352.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,915.77
|
| Rate for Payer: Quartz Commercial |
$5,194.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,794.82
|
| Rate for Payer: The Alliance Commercial |
$3,995.68
|
| Rate for Payer: WEA Trust Commercial |
$4,395.25
|
| Rate for Payer: WPS Commercial |
$5,918.99
|
|
|
STAPLE EASYFUSE 18 X 15 NITINOL 2-LEG FFS21815
|
Facility
|
IP
|
$7,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,915.77 |
| Max. Negotiated Rate |
$7,352.05 |
| Rate for Payer: Aetna Commercial |
$7,192.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,872.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,235.42
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,352.05
|
| Rate for Payer: Health EOS Commercial |
$7,112.31
|
| Rate for Payer: HFN Commercial |
$7,352.05
|
| Rate for Payer: Multiplan Commercial |
$6,393.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,352.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,915.77
|
| Rate for Payer: Quartz Commercial |
$4,794.82
|
| Rate for Payer: WEA Trust Commercial |
$4,395.25
|
| Rate for Payer: WPS Commercial |
$5,918.99
|
|
|
STAPLE EASYFUSE 18 X 20 NITINOL 2-LEG FFS21820
|
Facility
|
OP
|
$7,388.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,151.48 |
| Max. Negotiated Rate |
$7,069.16 |
| Rate for Payer: Aetna Commercial |
$6,915.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,608.13
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,841.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.45
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna Commercial |
$7,069.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,300.01
|
| Rate for Payer: Health EOS Commercial |
$6,838.65
|
| Rate for Payer: HFN Commercial |
$7,069.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,762.91
|
| Rate for Payer: Multiplan Commercial |
$6,147.10
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,069.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.10
|
| Rate for Payer: Quartz Commercial |
$4,994.52
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.32
|
| Rate for Payer: The Alliance Commercial |
$3,841.94
|
| Rate for Payer: WEA Trust Commercial |
$4,226.13
|
| Rate for Payer: WPS Commercial |
$5,691.24
|
|
|
STAPLE EASYFUSE 18 X 20 NITINOL 2-LEG FFS21820
|
Facility
|
IP
|
$7,388.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,765.10 |
| Max. Negotiated Rate |
$7,069.16 |
| Rate for Payer: Aetna Commercial |
$6,915.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,608.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.45
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna Commercial |
$7,069.16
|
| Rate for Payer: Health EOS Commercial |
$6,838.65
|
| Rate for Payer: HFN Commercial |
$7,069.16
|
| Rate for Payer: Multiplan Commercial |
$6,147.10
|
| Rate for Payer: Preferred Network Access Commercial |
$7,069.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.10
|
| Rate for Payer: Quartz Commercial |
$4,610.32
|
| Rate for Payer: WEA Trust Commercial |
$4,226.13
|
| Rate for Payer: WPS Commercial |
$5,691.24
|
|
|
STAPLE METRIC SUPER 13 X 10 X 10 1.5MM 17001
|
Facility
|
OP
|
$7,288.00
|
|
| Hospital Charge Code |
4389722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.27 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,926.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,789.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.62
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,684.64
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,547.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,926.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,547.71
|
| Rate for Payer: The Alliance Commercial |
$3,789.76
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
STAPLE METRIC SUPER 13 X 10 X 10 1.5MM 17001
|
Facility
|
IP
|
$7,288.00
|
|
| Hospital Charge Code |
4389722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,713.96 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,547.71
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
STAPLE METRIC SUPER 9 X 10 X 10MM 21301
|
Facility
|
OP
|
$7,288.00
|
|
| Hospital Charge Code |
4389721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.27 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,926.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,789.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.62
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,684.64
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,547.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,926.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,547.71
|
| Rate for Payer: The Alliance Commercial |
$3,789.76
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
STAPLE METRIC SUPER 9 X 10 X 10MM 21301
|
Facility
|
IP
|
$7,288.00
|
|
| Hospital Charge Code |
4389721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,713.96 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,547.71
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
STAPLE METRIC SUPER 9 X 9 X 9MM 21401
|
Facility
|
OP
|
$7,288.00
|
|
| Hospital Charge Code |
4389720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.27 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,926.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,789.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.62
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,684.64
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,547.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,926.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,547.71
|
| Rate for Payer: The Alliance Commercial |
$3,789.76
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
STAPLE METRIC SUPER 9 X 9 X 9MM 21401
|
Facility
|
IP
|
$7,288.00
|
|
| Hospital Charge Code |
4389720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,713.96 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$6,821.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.15
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,973.16
|
| Rate for Payer: Health EOS Commercial |
$6,745.77
|
| Rate for Payer: HFN Commercial |
$6,973.16
|
| Rate for Payer: Multiplan Commercial |
$6,063.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,713.96
|
| Rate for Payer: Quartz Commercial |
$4,547.71
|
| Rate for Payer: WEA Trust Commercial |
$4,168.74
|
| Rate for Payer: WPS Commercial |
$5,613.95
|
|
|
STAPLE NEOSPAN SUPERELASTIC COMPRESSION 10X10X10 WITH INSTRUMENTS T50 SN010
|
Facility
|
IP
|
$5,326.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.13 |
| Max. Negotiated Rate |
$5,095.92 |
| Rate for Payer: Aetna Commercial |
$4,985.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,763.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,935.69
|
| Rate for Payer: Cash Price |
$1,597.80
|
| Rate for Payer: Cigna Commercial |
$5,095.92
|
| Rate for Payer: Health EOS Commercial |
$4,929.75
|
| Rate for Payer: HFN Commercial |
$5,095.92
|
| Rate for Payer: Multiplan Commercial |
$4,431.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,095.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,714.13
|
| Rate for Payer: Quartz Commercial |
$3,323.42
|
| Rate for Payer: WEA Trust Commercial |
$3,046.47
|
| Rate for Payer: WPS Commercial |
$4,102.62
|
|
|
STAPLE NEOSPAN SUPERELASTIC COMPRESSION 10X10X10 WITH INSTRUMENTS T50 SN010
|
Facility
|
OP
|
$5,326.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.93 |
| Max. Negotiated Rate |
$5,095.92 |
| Rate for Payer: Aetna Commercial |
$4,985.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,763.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,550.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,600.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,769.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,658.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,935.69
|
| Rate for Payer: Cash Price |
$1,597.80
|
| Rate for Payer: Cigna Commercial |
$5,095.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,099.73
|
| Rate for Payer: Health EOS Commercial |
$4,929.75
|
| Rate for Payer: HFN Commercial |
$5,095.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,154.28
|
| Rate for Payer: Multiplan Commercial |
$4,431.23
|
| Rate for Payer: NAPHCARE Commercial |
$3,323.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,095.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,714.13
|
| Rate for Payer: Quartz Commercial |
$3,600.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,323.42
|
| Rate for Payer: The Alliance Commercial |
$2,769.52
|
| Rate for Payer: WEA Trust Commercial |
$3,046.47
|
| Rate for Payer: WPS Commercial |
$4,102.62
|
|
|
STAPLE NITINOL FUSEFORCE 8X8 FFNS0808
|
Facility
|
OP
|
$6,478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6212997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,886.39 |
| Max. Negotiated Rate |
$6,198.15 |
| Rate for Payer: Aetna Commercial |
$6,063.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,886.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,379.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,368.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,233.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,570.67
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$6,198.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,770.20
|
| Rate for Payer: Health EOS Commercial |
$5,996.04
|
| Rate for Payer: HFN Commercial |
$6,198.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,052.84
|
| Rate for Payer: Multiplan Commercial |
$5,389.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,042.27
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.19
|
| Rate for Payer: Quartz Commercial |
$4,379.13
|
| Rate for Payer: Quartz Medicare Advantage |
$4,042.27
|
| Rate for Payer: The Alliance Commercial |
$3,368.56
|
| Rate for Payer: WEA Trust Commercial |
$3,705.42
|
| Rate for Payer: WPS Commercial |
$4,990.00
|
|
