|
STAPER RELOAD 80-3.8 GIA8038L
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2962915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
STAPER RELOAD 80-3.8 GIA8038L
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2962915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
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 |
$6,502.79 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
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 |
$3,715.88 |
| Max. Negotiated Rate |
$53,084.00 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,715.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,626.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,370.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,426.45
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,953.25
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$8,626.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,962.60
|
| Rate for Payer: The Alliance Commercial |
$53,084.00
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
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 |
$3,715.88 |
| Max. Negotiated Rate |
$53,084.00 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,715.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,626.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,370.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,426.45
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,953.25
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$8,626.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,962.60
|
| Rate for Payer: The Alliance Commercial |
$53,084.00
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
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 |
$6,502.79 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
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 |
$6,502.79 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
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 |
$3,715.88 |
| Max. Negotiated Rate |
$53,084.00 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,715.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,626.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,370.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,426.45
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,953.25
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$8,626.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,962.60
|
| Rate for Payer: The Alliance Commercial |
$53,084.00
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
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 |
$3,765.16 |
| Max. Negotiated Rate |
$7,069.28 |
| Rate for Payer: Aetna Commercial |
$6,915.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,608.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.52
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,069.28
|
| Rate for Payer: Health EOS Commercial |
$6,838.76
|
| Rate for Payer: HFN Commercial |
$7,069.28
|
| Rate for Payer: Multiplan Commercial |
$6,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,069.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.16
|
| Rate for Payer: Quartz Commercial |
$4,610.40
|
| Rate for Payer: WEA Trust Commercial |
$4,226.20
|
| Rate for Payer: WPS Commercial |
$5,691.54
|
|
|
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 |
$2,151.52 |
| Max. Negotiated Rate |
$30,736.00 |
| Rate for Payer: Aetna Commercial |
$6,915.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,608.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.52
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,069.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.97
|
| Rate for Payer: Health EOS Commercial |
$6,838.76
|
| Rate for Payer: HFN Commercial |
$7,069.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,763.00
|
| Rate for Payer: Multiplan Commercial |
$6,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,069.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.16
|
| Rate for Payer: Quartz Commercial |
$4,994.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.40
|
| Rate for Payer: The Alliance Commercial |
$30,736.00
|
| Rate for Payer: WEA Trust Commercial |
$4,226.20
|
| Rate for Payer: WPS Commercial |
$5,691.54
|
|
|
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 |
$2,151.52 |
| Max. Negotiated Rate |
$30,736.00 |
| Rate for Payer: Aetna Commercial |
$6,915.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,608.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.52
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,069.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.97
|
| Rate for Payer: Health EOS Commercial |
$6,838.76
|
| Rate for Payer: HFN Commercial |
$7,069.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,763.00
|
| Rate for Payer: Multiplan Commercial |
$6,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,069.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.16
|
| Rate for Payer: Quartz Commercial |
$4,994.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.40
|
| Rate for Payer: The Alliance Commercial |
$30,736.00
|
| Rate for Payer: WEA Trust Commercial |
$4,226.20
|
| Rate for Payer: WPS Commercial |
$5,691.54
|
|
|
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 |
$3,765.16 |
| Max. Negotiated Rate |
$7,069.28 |
| Rate for Payer: Aetna Commercial |
$6,915.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,608.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.52
|
| Rate for Payer: Cash Price |
$2,305.20
|
| Rate for Payer: Cigna Commercial |
$7,069.28
|
| Rate for Payer: Health EOS Commercial |
$6,838.76
|
| Rate for Payer: HFN Commercial |
$7,069.28
|
| Rate for Payer: Multiplan Commercial |
$6,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,069.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.16
|
| Rate for Payer: Quartz Commercial |
$4,610.40
|
| Rate for Payer: WEA Trust Commercial |
$4,226.20
|
| Rate for Payer: WPS Commercial |
$5,691.54
|
|
|
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 |
$3,620.29 |
| Max. Negotiated Rate |
$6,797.27 |
| Rate for Payer: Aetna Commercial |
$6,649.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.82
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna Commercial |
$6,797.27
|
| Rate for Payer: Health EOS Commercial |
$6,575.62
|
| Rate for Payer: HFN Commercial |
$6,797.27
|
| Rate for Payer: Multiplan Commercial |
$5,910.67
|
| Rate for Payer: NAPHCARE Commercial |
$4,433.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,797.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.29
|
| Rate for Payer: Quartz Commercial |
$4,433.00
|
| Rate for Payer: WEA Trust Commercial |
$4,063.59
|
| Rate for Payer: WPS Commercial |
$5,472.54
|
|
|
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 |
$2,068.74 |
| Max. Negotiated Rate |
$29,553.36 |
| Rate for Payer: Aetna Commercial |
$6,649.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.97
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,802.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,694.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,546.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.82
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna Commercial |
$6,797.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,134.52
|
| Rate for Payer: Health EOS Commercial |
$6,575.62
|
| Rate for Payer: HFN Commercial |
$6,797.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,541.26
|
| Rate for Payer: Multiplan Commercial |
$5,910.67
|
| Rate for Payer: NAPHCARE Commercial |
$4,433.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,797.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.29
|
| Rate for Payer: Quartz Commercial |
$4,802.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4,433.00
|
| Rate for Payer: The Alliance Commercial |
$29,553.36
|
| Rate for Payer: WEA Trust Commercial |
$4,063.59
|
| Rate for Payer: WPS Commercial |
$5,472.54
|
|
|
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 |
$2,040.64 |
| Max. Negotiated Rate |
$29,152.00 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,737.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,644.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,498.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,078.36
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,466.00
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,737.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,372.80
|
| Rate for Payer: The Alliance Commercial |
$29,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
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 |
$3,571.12 |
| Max. Negotiated Rate |
$6,704.96 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,372.80
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
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 |
$2,040.64 |
| Max. Negotiated Rate |
$29,152.00 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,737.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,644.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,498.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,078.36
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,466.00
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,737.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,372.80
|
| Rate for Payer: The Alliance Commercial |
$29,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
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 |
$3,571.12 |
| Max. Negotiated Rate |
$6,704.96 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,372.80
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
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 |
$3,571.12 |
| Max. Negotiated Rate |
$6,704.96 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,372.80
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
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 |
$2,040.64 |
| Max. Negotiated Rate |
$29,152.00 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,737.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,644.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,498.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,078.36
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,466.00
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,737.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,372.80
|
| Rate for Payer: The Alliance Commercial |
$29,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
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 |
$2,609.74 |
| Max. Negotiated Rate |
$4,899.92 |
| Rate for Payer: Aetna Commercial |
$4,793.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.78
|
| Rate for Payer: Cash Price |
$1,597.80
|
| Rate for Payer: Cigna Commercial |
$4,899.92
|
| Rate for Payer: Health EOS Commercial |
$4,740.14
|
| Rate for Payer: HFN Commercial |
$4,899.92
|
| Rate for Payer: Multiplan Commercial |
$4,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.74
|
| Rate for Payer: Quartz Commercial |
$3,195.60
|
| Rate for Payer: WEA Trust Commercial |
$2,929.30
|
| Rate for Payer: WPS Commercial |
$3,944.97
|
|
|
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 |
$1,491.28 |
| Max. Negotiated Rate |
$21,304.00 |
| Rate for Payer: Aetna Commercial |
$4,793.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,580.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,491.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,461.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,663.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,556.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.78
|
| Rate for Payer: Cash Price |
$1,597.80
|
| Rate for Payer: Cigna Commercial |
$4,899.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,980.43
|
| Rate for Payer: Health EOS Commercial |
$4,740.14
|
| Rate for Payer: HFN Commercial |
$4,899.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,994.50
|
| Rate for Payer: Multiplan Commercial |
$4,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.74
|
| Rate for Payer: Quartz Commercial |
$3,461.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,195.60
|
| Rate for Payer: The Alliance Commercial |
$21,304.00
|
| Rate for Payer: WEA Trust Commercial |
$2,929.30
|
| Rate for Payer: WPS Commercial |
$3,944.97
|
|
|
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 |
$1,813.84 |
| Max. Negotiated Rate |
$25,912.00 |
| Rate for Payer: Aetna Commercial |
$5,830.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,571.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,813.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,210.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,109.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,433.34
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$5,959.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,625.09
|
| Rate for Payer: Health EOS Commercial |
$5,765.42
|
| Rate for Payer: HFN Commercial |
$5,959.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,858.50
|
| Rate for Payer: Multiplan Commercial |
$5,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,886.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,959.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,174.22
|
| Rate for Payer: Quartz Commercial |
$4,210.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,886.80
|
| Rate for Payer: The Alliance Commercial |
$25,912.00
|
| Rate for Payer: WEA Trust Commercial |
$3,562.90
|
| Rate for Payer: WPS Commercial |
$4,798.25
|
|
|
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 |
$3,174.22 |
| Max. Negotiated Rate |
$5,959.76 |
| Rate for Payer: Aetna Commercial |
$5,830.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,571.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,433.34
|
| Rate for Payer: Cash Price |
$1,943.40
|
| Rate for Payer: Cigna Commercial |
$5,959.76
|
| Rate for Payer: Health EOS Commercial |
$5,765.42
|
| Rate for Payer: HFN Commercial |
$5,959.76
|
| Rate for Payer: Multiplan Commercial |
$5,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,886.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,959.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,174.22
|
| Rate for Payer: Quartz Commercial |
$3,886.80
|
| Rate for Payer: WEA Trust Commercial |
$3,562.90
|
| Rate for Payer: WPS Commercial |
$4,798.25
|
|
|
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 |
$1,844.64 |
| Max. Negotiated Rate |
$26,352.00 |
| Rate for Payer: Aetna Commercial |
$5,929.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,665.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,844.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,282.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,162.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,491.64
|
| Rate for Payer: Cash Price |
$1,976.40
|
| Rate for Payer: Cigna Commercial |
$6,060.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,686.64
|
| Rate for Payer: Health EOS Commercial |
$5,863.32
|
| Rate for Payer: HFN Commercial |
$6,060.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,941.00
|
| Rate for Payer: Multiplan Commercial |
$5,270.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,952.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,060.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,228.12
|
| Rate for Payer: Quartz Commercial |
$4,282.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,952.80
|
| Rate for Payer: The Alliance Commercial |
$26,352.00
|
| Rate for Payer: WEA Trust Commercial |
$3,623.40
|
| Rate for Payer: WPS Commercial |
$4,879.73
|
|
