|
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 |
$3,228.12 |
| Max. Negotiated Rate |
$6,060.96 |
| Rate for Payer: Aetna Commercial |
$5,929.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,665.68
|
| 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: Health EOS Commercial |
$5,863.32
|
| Rate for Payer: HFN Commercial |
$6,060.96
|
| 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 |
$3,952.80
|
| Rate for Payer: WEA Trust Commercial |
$3,623.40
|
| Rate for Payer: WPS Commercial |
$4,879.73
|
|
|
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 |
$1,844.64 |
| 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
|
|
|
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 |
$3,228.12 |
| Max. Negotiated Rate |
$6,060.96 |
| Rate for Payer: Aetna Commercial |
$5,929.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,665.68
|
| 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: Health EOS Commercial |
$5,863.32
|
| Rate for Payer: HFN Commercial |
$6,060.96
|
| 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 |
$3,952.80
|
| Rate for Payer: WEA Trust Commercial |
$3,623.40
|
| Rate for Payer: WPS Commercial |
$4,879.73
|
|
|
STAPLER 30-3.5 ROTICULATOR
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
STAPLER 30-3.5 ROTICULATOR
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
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 |
$487.48 |
| Max. Negotiated Rate |
$6,964.00 |
| Rate for Payer: Aetna Commercial |
$1,566.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,497.26
|
| Rate for Payer: Aetna Managed Medicare |
$487.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,131.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$870.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$835.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.73
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,601.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$974.26
|
| Rate for Payer: Health EOS Commercial |
$1,549.49
|
| Rate for Payer: HFN Commercial |
$1,601.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,305.75
|
| Rate for Payer: Multiplan Commercial |
$1,392.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,601.72
|
| Rate for Payer: Quartz Beloit One Network |
$853.09
|
| Rate for Payer: Quartz Commercial |
$1,131.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,044.60
|
| Rate for Payer: The Alliance Commercial |
$6,964.00
|
| Rate for Payer: WEA Trust Commercial |
$957.55
|
| Rate for Payer: WPS Commercial |
$1,289.56
|
|
|
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 |
$853.09 |
| Max. Negotiated Rate |
$1,601.72 |
| Rate for Payer: Aetna Commercial |
$1,566.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,497.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.73
|
| Rate for Payer: Cash Price |
$522.30
|
| Rate for Payer: Cigna Commercial |
$1,601.72
|
| Rate for Payer: Health EOS Commercial |
$1,549.49
|
| Rate for Payer: HFN Commercial |
$1,601.72
|
| Rate for Payer: Multiplan Commercial |
$1,392.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,601.72
|
| Rate for Payer: Quartz Beloit One Network |
$853.09
|
| Rate for Payer: Quartz Commercial |
$1,044.60
|
| Rate for Payer: WEA Trust Commercial |
$957.55
|
| Rate for Payer: WPS Commercial |
$1,289.56
|
|
|
STAPLER 35MM ETS-FLEX ARTICULA
|
Facility
|
OP
|
$2,903.00
|
|
| Hospital Charge Code |
2965953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.84 |
| Max. Negotiated Rate |
$11,612.00 |
| Rate for Payer: Aetna Commercial |
$2,612.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,496.58
|
| Rate for Payer: Aetna Managed Medicare |
$812.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,393.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.59
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,670.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,624.52
|
| Rate for Payer: Health EOS Commercial |
$2,583.67
|
| Rate for Payer: HFN Commercial |
$2,670.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,177.25
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,670.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.47
|
| Rate for Payer: Quartz Commercial |
$1,886.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.80
|
| Rate for Payer: The Alliance Commercial |
$11,612.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.65
|
| Rate for Payer: WPS Commercial |
$2,150.25
|
|
|
STAPLER 35MM ETS-FLEX ARTICULA
|
Facility
|
IP
|
$2,903.00
|
|
| Hospital Charge Code |
2965953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,422.47 |
| Max. Negotiated Rate |
$2,670.76 |
| Rate for Payer: Aetna Commercial |
$2,612.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,496.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.59
|
| Rate for Payer: Cash Price |
$870.90
|
| Rate for Payer: Cigna Commercial |
$2,670.76
|
| Rate for Payer: Health EOS Commercial |
$2,583.67
|
| Rate for Payer: HFN Commercial |
$2,670.76
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,670.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.47
|
| Rate for Payer: Quartz Commercial |
$1,741.80
|
| Rate for Payer: WEA Trust Commercial |
$1,596.65
|
| Rate for Payer: WPS Commercial |
$2,150.25
|
|
|
STAPLER 45-3.5 RELOADABLE
|
Facility
|
OP
|
$3,145.00
|
|
| Hospital Charge Code |
2969250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.60 |
| Max. Negotiated Rate |
$12,580.00 |
| Rate for Payer: Aetna Commercial |
$2,830.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,704.70
|
| Rate for Payer: Aetna Managed Medicare |
$880.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,044.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,572.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,509.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,666.85
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$2,893.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,759.94
|
| Rate for Payer: Health EOS Commercial |
$2,799.05
|
| Rate for Payer: HFN Commercial |
$2,893.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,358.75
|
| Rate for Payer: Multiplan Commercial |
$2,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,887.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,893.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.05
|
| Rate for Payer: Quartz Commercial |
$2,044.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,887.00
|
| Rate for Payer: The Alliance Commercial |
$12,580.00
|
| Rate for Payer: WEA Trust Commercial |
$1,729.75
|
| Rate for Payer: WPS Commercial |
$2,329.50
|
|
|
STAPLER 45-3.5 RELOADABLE
|
Facility
|
IP
|
$3,145.00
|
|
| Hospital Charge Code |
2969250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,541.05 |
| Max. Negotiated Rate |
$2,893.40 |
| Rate for Payer: Aetna Commercial |
$2,830.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,704.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,666.85
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$2,893.40
|
| Rate for Payer: Health EOS Commercial |
$2,799.05
|
| Rate for Payer: HFN Commercial |
$2,893.40
|
| Rate for Payer: Multiplan Commercial |
$2,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,887.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,893.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.05
|
| Rate for Payer: Quartz Commercial |
$1,887.00
|
| Rate for Payer: WEA Trust Commercial |
$1,729.75
|
| Rate for Payer: WPS Commercial |
$2,329.50
|
|
|
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 |
$1,541.05 |
| Max. Negotiated Rate |
$2,893.40 |
| Rate for Payer: Aetna Commercial |
$2,830.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,704.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,666.85
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$2,893.40
|
| Rate for Payer: Health EOS Commercial |
$2,799.05
|
| Rate for Payer: HFN Commercial |
$2,893.40
|
| Rate for Payer: Multiplan Commercial |
$2,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,887.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,893.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.05
|
| Rate for Payer: Quartz Commercial |
$1,887.00
|
| Rate for Payer: WEA Trust Commercial |
$1,729.75
|
| Rate for Payer: WPS Commercial |
$2,329.50
|
|
|
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 |
$880.60 |
| Max. Negotiated Rate |
$12,580.00 |
| Rate for Payer: Aetna Commercial |
$2,830.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,704.70
|
| Rate for Payer: Aetna Managed Medicare |
$880.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,044.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,572.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,509.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,666.85
|
| Rate for Payer: Cash Price |
$943.50
|
| Rate for Payer: Cigna Commercial |
$2,893.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,759.94
|
| Rate for Payer: Health EOS Commercial |
$2,799.05
|
| Rate for Payer: HFN Commercial |
$2,893.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,358.75
|
| Rate for Payer: Multiplan Commercial |
$2,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,887.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,893.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.05
|
| Rate for Payer: Quartz Commercial |
$2,044.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,887.00
|
| Rate for Payer: The Alliance Commercial |
$12,580.00
|
| Rate for Payer: WEA Trust Commercial |
$1,729.75
|
| Rate for Payer: WPS Commercial |
$2,329.50
|
|
|
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 |
$1,534.68 |
| Max. Negotiated Rate |
$2,881.44 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$1,879.20
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
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 |
$876.96 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Aetna Managed Medicare |
$876.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.67
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,349.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$2,035.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,879.20
|
| Rate for Payer: The Alliance Commercial |
$12,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
STAPLER 90-3.5 RELOADABLE TA9035S
|
Facility
|
IP
|
$1,922.00
|
|
| Hospital Charge Code |
2962977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.78 |
| Max. Negotiated Rate |
$1,768.24 |
| Rate for Payer: Aetna Commercial |
$1,729.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.66
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,768.24
|
| Rate for Payer: Health EOS Commercial |
$1,710.58
|
| Rate for Payer: HFN Commercial |
$1,768.24
|
| Rate for Payer: Multiplan Commercial |
$1,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,153.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.24
|
| Rate for Payer: Quartz Beloit One Network |
$941.78
|
| Rate for Payer: Quartz Commercial |
$1,153.20
|
| Rate for Payer: WEA Trust Commercial |
$1,057.10
|
| Rate for Payer: WPS Commercial |
$1,423.63
|
|
|
STAPLER 90-3.5 RELOADABLE TA9035S
|
Facility
|
OP
|
$1,922.00
|
|
| Hospital Charge Code |
2962977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.16 |
| Max. Negotiated Rate |
$7,688.00 |
| Rate for Payer: Aetna Commercial |
$1,729.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.92
|
| Rate for Payer: Aetna Managed Medicare |
$538.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,249.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$922.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.66
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,768.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,075.55
|
| Rate for Payer: Health EOS Commercial |
$1,710.58
|
| Rate for Payer: HFN Commercial |
$1,768.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,441.50
|
| Rate for Payer: Multiplan Commercial |
$1,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,153.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.24
|
| Rate for Payer: Quartz Beloit One Network |
$941.78
|
| Rate for Payer: Quartz Commercial |
$1,249.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,153.20
|
| Rate for Payer: The Alliance Commercial |
$7,688.00
|
| Rate for Payer: WEA Trust Commercial |
$1,057.10
|
| Rate for Payer: WPS Commercial |
$1,423.63
|
|
|
STAPLER 90-4.8 RELOADABLE TA9048S
|
Facility
|
OP
|
$3,486.00
|
|
| Hospital Charge Code |
5917646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$976.08 |
| Max. Negotiated Rate |
$13,944.00 |
| Rate for Payer: Aetna Commercial |
$3,137.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,997.96
|
| Rate for Payer: Aetna Managed Medicare |
$976.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,265.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,743.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,673.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,847.58
|
| Rate for Payer: Cash Price |
$1,045.80
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,950.77
|
| Rate for Payer: Health EOS Commercial |
$3,102.54
|
| Rate for Payer: HFN Commercial |
$3,207.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,614.50
|
| Rate for Payer: Multiplan Commercial |
$2,788.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,091.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,207.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.14
|
| Rate for Payer: Quartz Commercial |
$2,265.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,091.60
|
| Rate for Payer: The Alliance Commercial |
$13,944.00
|
| Rate for Payer: WEA Trust Commercial |
$1,917.30
|
| Rate for Payer: WPS Commercial |
$2,582.08
|
|
|
STAPLER 90-4.8 RELOADABLE TA9048S
|
Facility
|
IP
|
$3,486.00
|
|
| Hospital Charge Code |
5917646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,708.14 |
| Max. Negotiated Rate |
$3,207.12 |
| Rate for Payer: Aetna Commercial |
$3,137.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,997.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,847.58
|
| Rate for Payer: Cash Price |
$1,045.80
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: Health EOS Commercial |
$3,102.54
|
| Rate for Payer: HFN Commercial |
$3,207.12
|
| Rate for Payer: Multiplan Commercial |
$2,788.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,091.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,207.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.14
|
| Rate for Payer: Quartz Commercial |
$2,091.60
|
| Rate for Payer: WEA Trust Commercial |
$1,917.30
|
| Rate for Payer: WPS Commercial |
$2,582.08
|
|
|
STAPLER ARTIC ENDO ETS FLEX45 ATS45
|
Facility
|
OP
|
$2,556.00
|
|
| Hospital Charge Code |
4491011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.68 |
| Max. Negotiated Rate |
$10,224.00 |
| Rate for Payer: Aetna Commercial |
$2,300.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,198.16
|
| Rate for Payer: Aetna Managed Medicare |
$715.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,661.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,226.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,354.68
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$2,351.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.34
|
| Rate for Payer: Health EOS Commercial |
$2,274.84
|
| Rate for Payer: HFN Commercial |
$2,351.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.00
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,533.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,351.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.44
|
| Rate for Payer: Quartz Commercial |
$1,661.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,533.60
|
| Rate for Payer: The Alliance Commercial |
$10,224.00
|
| Rate for Payer: WEA Trust Commercial |
$1,405.80
|
| Rate for Payer: WPS Commercial |
$1,893.23
|
|
|
STAPLER ARTIC ENDO ETS FLEX45 ATS45
|
Facility
|
IP
|
$2,556.00
|
|
| Hospital Charge Code |
4491011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,252.44 |
| Max. Negotiated Rate |
$2,351.52 |
| Rate for Payer: Aetna Commercial |
$2,300.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,198.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,354.68
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$2,351.52
|
| Rate for Payer: Health EOS Commercial |
$2,274.84
|
| Rate for Payer: HFN Commercial |
$2,351.52
|
| Rate for Payer: Multiplan Commercial |
$2,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,533.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,351.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.44
|
| Rate for Payer: Quartz Commercial |
$1,533.60
|
| Rate for Payer: WEA Trust Commercial |
$1,405.80
|
| Rate for Payer: WPS Commercial |
$1,893.23
|
|
|
STAPLER CONTOUR LOADED W/BLUE CARTRIDGE CS40B/GCS40B
|
Facility
|
OP
|
$6,330.00
|
|
| Hospital Charge Code |
3376920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,772.40 |
| Max. Negotiated Rate |
$25,320.00 |
| Rate for Payer: Aetna Commercial |
$5,697.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,443.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,772.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,114.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,038.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,354.90
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna Commercial |
$5,823.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,542.27
|
| Rate for Payer: Health EOS Commercial |
$5,633.70
|
| Rate for Payer: HFN Commercial |
$5,823.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,747.50
|
| Rate for Payer: Multiplan Commercial |
$5,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,823.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,101.70
|
| Rate for Payer: Quartz Commercial |
$4,114.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,798.00
|
| Rate for Payer: The Alliance Commercial |
$25,320.00
|
| Rate for Payer: WEA Trust Commercial |
$3,481.50
|
| Rate for Payer: WPS Commercial |
$4,688.63
|
|
|
STAPLER CONTOUR LOADED W/BLUE CARTRIDGE CS40B/GCS40B
|
Facility
|
IP
|
$6,330.00
|
|
| Hospital Charge Code |
3376920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,101.70 |
| Max. Negotiated Rate |
$5,823.60 |
| Rate for Payer: Aetna Commercial |
$5,697.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,443.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,354.90
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna Commercial |
$5,823.60
|
| Rate for Payer: Health EOS Commercial |
$5,633.70
|
| Rate for Payer: HFN Commercial |
$5,823.60
|
| Rate for Payer: Multiplan Commercial |
$5,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,823.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,101.70
|
| Rate for Payer: Quartz Commercial |
$3,798.00
|
| Rate for Payer: WEA Trust Commercial |
$3,481.50
|
| Rate for Payer: WPS Commercial |
$4,688.63
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 23MM CDH23P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5729637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,333.38 |
| Max. Negotiated Rate |
$4,381.04 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$2,857.20
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 23MM CDH23P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5729637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.36 |
| Max. Negotiated Rate |
$19,048.00 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,095.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,285.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,664.82
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,571.50
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$3,095.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.20
|
| Rate for Payer: The Alliance Commercial |
$19,048.00
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
