|
STAPLE NITINOL FUSEFORCE 8X8 FFNS0808
|
Facility
|
IP
|
$6,478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6212997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,301.19 |
| 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: 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: Health EOS Commercial |
$5,996.04
|
| Rate for Payer: HFN Commercial |
$6,198.15
|
| Rate for Payer: Multiplan Commercial |
$5,389.70
|
| 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 |
$4,042.27
|
| Rate for Payer: WEA Trust Commercial |
$3,705.42
|
| Rate for Payer: WPS Commercial |
$4,990.00
|
|
|
STAPLE NITINOL MEMOFIX 08 X 08 X 08 MS080808
|
Facility
|
IP
|
$6,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5521014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.24 |
| Max. Negotiated Rate |
$6,303.40 |
| Rate for Payer: Aetna Commercial |
$6,166.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,892.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,631.31
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$6,303.40
|
| Rate for Payer: Health EOS Commercial |
$6,097.85
|
| Rate for Payer: HFN Commercial |
$6,303.40
|
| Rate for Payer: Multiplan Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,303.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,357.24
|
| Rate for Payer: Quartz Commercial |
$4,110.91
|
| Rate for Payer: WEA Trust Commercial |
$3,768.34
|
| Rate for Payer: WPS Commercial |
$5,074.74
|
|
|
STAPLE NITINOL MEMOFIX 08 X 08 X 08 MS080808
|
Facility
|
OP
|
$6,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5521014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,918.43 |
| Max. Negotiated Rate |
$6,303.40 |
| Rate for Payer: Aetna Commercial |
$6,166.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,892.31
|
| Rate for Payer: Aetna Managed Medicare |
$1,918.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,453.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,425.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,288.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,631.31
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$6,303.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,834.22
|
| Rate for Payer: Health EOS Commercial |
$6,097.85
|
| Rate for Payer: HFN Commercial |
$6,303.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,138.64
|
| Rate for Payer: Multiplan Commercial |
$5,481.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,110.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,303.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,357.24
|
| Rate for Payer: Quartz Commercial |
$4,453.49
|
| Rate for Payer: Quartz Medicare Advantage |
$4,110.91
|
| Rate for Payer: The Alliance Commercial |
$3,425.76
|
| Rate for Payer: WEA Trust Commercial |
$3,768.34
|
| Rate for Payer: WPS Commercial |
$5,074.74
|
|
|
STAPLE NITINOL MEMOFIX 10 X 10 X 10 MS101010
|
Facility
|
OP
|
$6,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5521015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,918.43 |
| Max. Negotiated Rate |
$6,303.40 |
| Rate for Payer: Aetna Commercial |
$6,166.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,892.31
|
| Rate for Payer: Aetna Managed Medicare |
$1,918.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,453.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,425.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,288.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,631.31
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$6,303.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,834.22
|
| Rate for Payer: Health EOS Commercial |
$6,097.85
|
| Rate for Payer: HFN Commercial |
$6,303.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,138.64
|
| Rate for Payer: Multiplan Commercial |
$5,481.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,110.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,303.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,357.24
|
| Rate for Payer: Quartz Commercial |
$4,453.49
|
| Rate for Payer: Quartz Medicare Advantage |
$4,110.91
|
| Rate for Payer: The Alliance Commercial |
$3,425.76
|
| Rate for Payer: WEA Trust Commercial |
$3,768.34
|
| Rate for Payer: WPS Commercial |
$5,074.74
|
|
|
STAPLE NITINOL MEMOFIX 10 X 10 X 10 MS101010
|
Facility
|
IP
|
$6,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5521015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.24 |
| Max. Negotiated Rate |
$6,303.40 |
| Rate for Payer: Aetna Commercial |
$6,166.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,892.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,631.31
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$6,303.40
|
| Rate for Payer: Health EOS Commercial |
$6,097.85
|
| Rate for Payer: HFN Commercial |
$6,303.40
|
| Rate for Payer: Multiplan Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,303.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,357.24
|
| Rate for Payer: Quartz Commercial |
$4,110.91
|
| Rate for Payer: WEA Trust Commercial |
$3,768.34
|
| Rate for Payer: WPS Commercial |
$5,074.74
|
|
|
STAPLER 30-3.5 ROTICULATOR
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
STAPLER 30-3.5 ROTICULATOR
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
STAPLER 30MM BLUE 30-3.5
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$1,665.79 |
| Rate for Payer: Aetna Commercial |
$1,629.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.64
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,665.79
|
| Rate for Payer: Health EOS Commercial |
$1,611.47
|
| Rate for Payer: HFN Commercial |
$1,665.79
|
| Rate for Payer: Multiplan Commercial |
$1,448.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.79
|
| Rate for Payer: Quartz Beloit One Network |
$887.21
|
| Rate for Payer: Quartz Commercial |
$1,086.38
|
| Rate for Payer: WEA Trust Commercial |
$995.85
|
| Rate for Payer: WPS Commercial |
$1,341.09
|
|
|
STAPLER 30MM BLUE 30-3.5
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.98 |
| Max. Negotiated Rate |
$1,665.79 |
| Rate for Payer: Aetna Commercial |
$1,629.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.15
|
| Rate for Payer: Aetna Managed Medicare |
$506.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,176.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$905.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.64
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,665.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,013.26
|
| Rate for Payer: Health EOS Commercial |
$1,611.47
|
| Rate for Payer: HFN Commercial |
$1,665.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.98
|
| Rate for Payer: Multiplan Commercial |
$1,448.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.79
|
| Rate for Payer: Quartz Beloit One Network |
$887.21
|
| Rate for Payer: Quartz Commercial |
$1,176.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,086.38
|
| Rate for Payer: The Alliance Commercial |
$905.32
|
| Rate for Payer: WEA Trust Commercial |
$995.85
|
| Rate for Payer: WPS Commercial |
$1,341.09
|
|
|
STAPLER 35MM ETS-FLEX ARTICULA
|
Facility
|
OP
|
$2,903.00
|
|
| Hospital Charge Code |
2965953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.35 |
| Max. Negotiated Rate |
$2,777.59 |
| Rate for Payer: Aetna Commercial |
$2,717.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,596.44
|
| Rate for Payer: Aetna Managed Medicare |
$845.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,962.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,449.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.13
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,777.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,689.55
|
| Rate for Payer: Health EOS Commercial |
$2,687.02
|
| Rate for Payer: HFN Commercial |
$2,777.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,264.34
|
| Rate for Payer: Multiplan Commercial |
$2,415.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,811.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,777.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.37
|
| Rate for Payer: Quartz Commercial |
$1,962.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,811.47
|
| Rate for Payer: The Alliance Commercial |
$1,509.56
|
| Rate for Payer: WEA Trust Commercial |
$1,660.52
|
| Rate for Payer: WPS Commercial |
$2,236.18
|
|
|
STAPLER 35MM ETS-FLEX ARTICULA
|
Facility
|
IP
|
$2,903.00
|
|
| Hospital Charge Code |
2965953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,479.37 |
| Max. Negotiated Rate |
$2,777.59 |
| Rate for Payer: Aetna Commercial |
$2,717.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,596.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.13
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,777.59
|
| Rate for Payer: Health EOS Commercial |
$2,687.02
|
| Rate for Payer: HFN Commercial |
$2,777.59
|
| Rate for Payer: Multiplan Commercial |
$2,415.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,777.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.37
|
| Rate for Payer: Quartz Commercial |
$1,811.47
|
| Rate for Payer: WEA Trust Commercial |
$1,660.52
|
| Rate for Payer: WPS Commercial |
$2,236.18
|
|
|
STAPLER 45-3.5 RELOADABLE
|
Facility
|
OP
|
$3,145.00
|
|
| Hospital Charge Code |
2969250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.82 |
| Max. Negotiated Rate |
$3,009.14 |
| Rate for Payer: Aetna Commercial |
$2,943.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,812.89
|
| Rate for Payer: Aetna Managed Medicare |
$915.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,126.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,635.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,569.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,733.52
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$3,009.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,830.39
|
| Rate for Payer: Health EOS Commercial |
$2,911.01
|
| Rate for Payer: HFN Commercial |
$3,009.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,453.10
|
| Rate for Payer: Multiplan Commercial |
$2,616.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,962.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,009.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,602.69
|
| Rate for Payer: Quartz Commercial |
$2,126.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,962.48
|
| Rate for Payer: The Alliance Commercial |
$1,635.40
|
| Rate for Payer: WEA Trust Commercial |
$1,798.94
|
| Rate for Payer: WPS Commercial |
$2,422.59
|
|
|
STAPLER 45-3.5 RELOADABLE
|
Facility
|
IP
|
$3,145.00
|
|
| Hospital Charge Code |
2969250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.69 |
| Max. Negotiated Rate |
$3,009.14 |
| Rate for Payer: Aetna Commercial |
$2,943.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,812.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,733.52
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$3,009.14
|
| Rate for Payer: Health EOS Commercial |
$2,911.01
|
| Rate for Payer: HFN Commercial |
$3,009.14
|
| Rate for Payer: Multiplan Commercial |
$2,616.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,009.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,602.69
|
| Rate for Payer: Quartz Commercial |
$1,962.48
|
| Rate for Payer: WEA Trust Commercial |
$1,798.94
|
| Rate for Payer: WPS Commercial |
$2,422.59
|
|
|
STAPLER 45-4.8 RELOADABLE
|
Facility
|
IP
|
$3,145.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.69 |
| Max. Negotiated Rate |
$3,009.14 |
| Rate for Payer: Aetna Commercial |
$2,943.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,812.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,733.52
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$3,009.14
|
| Rate for Payer: Health EOS Commercial |
$2,911.01
|
| Rate for Payer: HFN Commercial |
$3,009.14
|
| Rate for Payer: Multiplan Commercial |
$2,616.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,009.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,602.69
|
| Rate for Payer: Quartz Commercial |
$1,962.48
|
| Rate for Payer: WEA Trust Commercial |
$1,798.94
|
| Rate for Payer: WPS Commercial |
$2,422.59
|
|
|
STAPLER 45-4.8 RELOADABLE
|
Facility
|
OP
|
$3,145.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.82 |
| Max. Negotiated Rate |
$3,009.14 |
| Rate for Payer: Aetna Commercial |
$2,943.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,812.89
|
| Rate for Payer: Aetna Managed Medicare |
$915.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,126.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,635.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,569.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,733.52
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$3,009.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,830.39
|
| Rate for Payer: Health EOS Commercial |
$2,911.01
|
| Rate for Payer: HFN Commercial |
$3,009.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,453.10
|
| Rate for Payer: Multiplan Commercial |
$2,616.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,962.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,009.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,602.69
|
| Rate for Payer: Quartz Commercial |
$2,126.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,962.48
|
| Rate for Payer: The Alliance Commercial |
$1,635.40
|
| Rate for Payer: WEA Trust Commercial |
$1,798.94
|
| Rate for Payer: WPS Commercial |
$2,422.59
|
|
|
STAPLER 55-3.5 ROTICULATOR
|
Facility
|
OP
|
$3,132.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.04 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Aetna Managed Medicare |
$912.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,117.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,628.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,563.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,822.82
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,442.96
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$2,117.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,954.37
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
STAPLER 55-3.5 ROTICULATOR
|
Facility
|
IP
|
$3,132.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.07 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$1,954.37
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
STAPLER 90-3.5 RELOADABLE TA9035S
|
Facility
|
OP
|
$1,922.00
|
|
| Hospital Charge Code |
2962977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.69 |
| Max. Negotiated Rate |
$1,838.97 |
| Rate for Payer: Aetna Commercial |
$1,798.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.04
|
| Rate for Payer: Aetna Managed Medicare |
$559.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,299.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$999.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$959.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,059.41
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,838.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,118.60
|
| Rate for Payer: Health EOS Commercial |
$1,779.00
|
| Rate for Payer: HFN Commercial |
$1,838.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,499.16
|
| Rate for Payer: Multiplan Commercial |
$1,599.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,199.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,838.97
|
| Rate for Payer: Quartz Beloit One Network |
$979.45
|
| Rate for Payer: Quartz Commercial |
$1,299.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,199.33
|
| Rate for Payer: The Alliance Commercial |
$999.44
|
| Rate for Payer: WEA Trust Commercial |
$1,099.38
|
| Rate for Payer: WPS Commercial |
$1,480.52
|
|
|
STAPLER 90-3.5 RELOADABLE TA9035S
|
Facility
|
IP
|
$1,922.00
|
|
| Hospital Charge Code |
2962977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.45 |
| Max. Negotiated Rate |
$1,838.97 |
| Rate for Payer: Aetna Commercial |
$1,798.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,059.41
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,838.97
|
| Rate for Payer: Health EOS Commercial |
$1,779.00
|
| Rate for Payer: HFN Commercial |
$1,838.97
|
| Rate for Payer: Multiplan Commercial |
$1,599.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,838.97
|
| Rate for Payer: Quartz Beloit One Network |
$979.45
|
| Rate for Payer: Quartz Commercial |
$1,199.33
|
| Rate for Payer: WEA Trust Commercial |
$1,099.38
|
| Rate for Payer: WPS Commercial |
$1,480.52
|
|
|
STAPLER 90-4.8 RELOADABLE TA9048S
|
Facility
|
OP
|
$3,486.00
|
|
| Hospital Charge Code |
5917646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,015.12 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Aetna Commercial |
$3,262.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,117.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,015.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,356.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,812.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,740.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,921.48
|
| Rate for Payer: Cash Price |
$1,045.80
|
| Rate for Payer: Cigna Commercial |
$3,335.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,028.85
|
| Rate for Payer: Health EOS Commercial |
$3,226.64
|
| Rate for Payer: HFN Commercial |
$3,335.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,719.08
|
| Rate for Payer: Multiplan Commercial |
$2,900.35
|
| Rate for Payer: NAPHCARE Commercial |
$2,175.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,335.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.47
|
| Rate for Payer: Quartz Commercial |
$2,356.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,175.26
|
| Rate for Payer: The Alliance Commercial |
$1,812.72
|
| Rate for Payer: WEA Trust Commercial |
$1,993.99
|
| Rate for Payer: WPS Commercial |
$2,685.27
|
|
|
STAPLER 90-4.8 RELOADABLE TA9048S
|
Facility
|
IP
|
$3,486.00
|
|
| Hospital Charge Code |
5917646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,776.47 |
| Max. Negotiated Rate |
$3,335.40 |
| Rate for Payer: Aetna Commercial |
$3,262.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,117.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,921.48
|
| Rate for Payer: Cash Price |
$1,045.80
|
| Rate for Payer: Cigna Commercial |
$3,335.40
|
| Rate for Payer: Health EOS Commercial |
$3,226.64
|
| Rate for Payer: HFN Commercial |
$3,335.40
|
| Rate for Payer: Multiplan Commercial |
$2,900.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,335.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.47
|
| Rate for Payer: Quartz Commercial |
$2,175.26
|
| Rate for Payer: WEA Trust Commercial |
$1,993.99
|
| Rate for Payer: WPS Commercial |
$2,685.27
|
|
|
STAPLER ARTIC ENDO ETS FLEX45 ATS45
|
Facility
|
OP
|
$2,556.00
|
|
| Hospital Charge Code |
4491011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.31 |
| Max. Negotiated Rate |
$2,445.58 |
| Rate for Payer: Aetna Commercial |
$2,392.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.09
|
| Rate for Payer: Aetna Managed Medicare |
$744.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,727.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,275.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,408.87
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$2,445.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,487.59
|
| Rate for Payer: Health EOS Commercial |
$2,365.83
|
| Rate for Payer: HFN Commercial |
$2,445.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,993.68
|
| Rate for Payer: Multiplan Commercial |
$2,126.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.54
|
| Rate for Payer: Quartz Commercial |
$1,727.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,594.94
|
| Rate for Payer: The Alliance Commercial |
$1,329.12
|
| Rate for Payer: WEA Trust Commercial |
$1,462.03
|
| Rate for Payer: WPS Commercial |
$1,968.89
|
|
|
STAPLER ARTIC ENDO ETS FLEX45 ATS45
|
Facility
|
IP
|
$2,556.00
|
|
| Hospital Charge Code |
4491011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,302.54 |
| Max. Negotiated Rate |
$2,445.58 |
| Rate for Payer: Aetna Commercial |
$2,392.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,408.87
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$2,445.58
|
| Rate for Payer: Health EOS Commercial |
$2,365.83
|
| Rate for Payer: HFN Commercial |
$2,445.58
|
| Rate for Payer: Multiplan Commercial |
$2,126.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,302.54
|
| Rate for Payer: Quartz Commercial |
$1,594.94
|
| Rate for Payer: WEA Trust Commercial |
$1,462.03
|
| Rate for Payer: WPS Commercial |
$1,968.89
|
|
|
STAPLER CONTOUR LOADED W/BLUE CARTRIDGE CS40B/GCS40B
|
Facility
|
IP
|
$6,330.00
|
|
| Hospital Charge Code |
3376920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,225.77 |
| Max. Negotiated Rate |
$6,056.54 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,661.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,489.10
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna Commercial |
$6,056.54
|
| Rate for Payer: Health EOS Commercial |
$5,859.05
|
| Rate for Payer: HFN Commercial |
$6,056.54
|
| Rate for Payer: Multiplan Commercial |
$5,266.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6,056.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,225.77
|
| Rate for Payer: Quartz Commercial |
$3,949.92
|
| Rate for Payer: WEA Trust Commercial |
$3,620.76
|
| Rate for Payer: WPS Commercial |
$4,876.00
|
|
|
STAPLER CONTOUR LOADED W/BLUE CARTRIDGE CS40B/GCS40B
|
Facility
|
OP
|
$6,330.00
|
|
| Hospital Charge Code |
3376920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,843.30 |
| Max. Negotiated Rate |
$6,056.54 |
| Rate for Payer: Aetna Commercial |
$5,924.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,661.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,843.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,279.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,291.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,159.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,489.10
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna Commercial |
$6,056.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,684.06
|
| Rate for Payer: Health EOS Commercial |
$5,859.05
|
| Rate for Payer: HFN Commercial |
$6,056.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,937.40
|
| Rate for Payer: Multiplan Commercial |
$5,266.56
|
| Rate for Payer: NAPHCARE Commercial |
$3,949.92
|
| Rate for Payer: Preferred Network Access Commercial |
$6,056.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,225.77
|
| Rate for Payer: Quartz Commercial |
$4,279.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,949.92
|
| Rate for Payer: The Alliance Commercial |
$3,291.60
|
| Rate for Payer: WEA Trust Commercial |
$3,620.76
|
| Rate for Payer: WPS Commercial |
$4,876.00
|
|
