|
STAPLER HEMORRHOID CIRCULAR PPH03
|
Facility
|
OP
|
$5,314.00
|
|
| Hospital Charge Code |
2969373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,487.92 |
| Max. Negotiated Rate |
$21,256.00 |
| Rate for Payer: Aetna Commercial |
$4,782.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,487.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,550.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.42
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$4,888.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,973.71
|
| Rate for Payer: Health EOS Commercial |
$4,729.46
|
| Rate for Payer: HFN Commercial |
$4,888.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,985.50
|
| Rate for Payer: Multiplan Commercial |
$4,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,888.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,603.86
|
| Rate for Payer: Quartz Commercial |
$3,454.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,188.40
|
| Rate for Payer: The Alliance Commercial |
$21,256.00
|
| Rate for Payer: WEA Trust Commercial |
$2,922.70
|
| Rate for Payer: WPS Commercial |
$3,936.08
|
|
|
STAPLER HEMORRHOID CIRCULAR PPH03
|
Facility
|
IP
|
$5,314.00
|
|
| Hospital Charge Code |
2969373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.86 |
| Max. Negotiated Rate |
$4,888.88 |
| Rate for Payer: Aetna Commercial |
$4,782.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.42
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$4,888.88
|
| Rate for Payer: Health EOS Commercial |
$4,729.46
|
| Rate for Payer: HFN Commercial |
$4,888.88
|
| Rate for Payer: Multiplan Commercial |
$4,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,888.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,603.86
|
| Rate for Payer: Quartz Commercial |
$3,188.40
|
| Rate for Payer: WEA Trust Commercial |
$2,922.70
|
| Rate for Payer: WPS Commercial |
$3,936.08
|
|
|
STAPLER LDS POWERED 15W
|
Facility
|
IP
|
$1,977.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.73 |
| Max. Negotiated Rate |
$1,818.84 |
| Rate for Payer: Aetna Commercial |
$1,779.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.81
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,818.84
|
| Rate for Payer: Health EOS Commercial |
$1,759.53
|
| Rate for Payer: HFN Commercial |
$1,818.84
|
| Rate for Payer: Multiplan Commercial |
$1,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.84
|
| Rate for Payer: Quartz Beloit One Network |
$968.73
|
| Rate for Payer: Quartz Commercial |
$1,186.20
|
| Rate for Payer: WEA Trust Commercial |
$1,087.35
|
| Rate for Payer: WPS Commercial |
$1,464.36
|
|
|
STAPLER LDS POWERED 15W
|
Facility
|
OP
|
$1,977.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.56 |
| Max. Negotiated Rate |
$7,908.00 |
| Rate for Payer: Aetna Commercial |
$1,779.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.22
|
| Rate for Payer: Aetna Managed Medicare |
$553.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,285.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.81
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,818.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,106.33
|
| Rate for Payer: Health EOS Commercial |
$1,759.53
|
| Rate for Payer: HFN Commercial |
$1,818.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.75
|
| Rate for Payer: Multiplan Commercial |
$1,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.84
|
| Rate for Payer: Quartz Beloit One Network |
$968.73
|
| Rate for Payer: Quartz Commercial |
$1,285.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,186.20
|
| Rate for Payer: The Alliance Commercial |
$7,908.00
|
| Rate for Payer: WEA Trust Commercial |
$1,087.35
|
| Rate for Payer: WPS Commercial |
$1,464.36
|
|
|
STAPLER LIN 30-3.5 SNGL USE
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.27 |
| Max. Negotiated Rate |
$1,585.16 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,033.80
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
STAPLER LIN 30-3.5 SNGL USE
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.44 |
| Max. Negotiated Rate |
$6,892.00 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$482.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,119.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$861.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.19
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,292.25
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,119.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.80
|
| Rate for Payer: The Alliance Commercial |
$6,892.00
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
STAPLER LIN CUT 80-3.8 GIA8035S
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
2962924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
STAPLER LIN CUT 80-3.8 GIA8035S
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
2962924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.76 |
| Max. Negotiated Rate |
$6,768.00 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$473.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,015.20
|
| Rate for Payer: The Alliance Commercial |
$6,768.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
STAPLER LINEAR 90MM TLH90/TCT10
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.07 |
| Max. Negotiated Rate |
$1,419.56 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.79
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,419.56
|
| Rate for Payer: Health EOS Commercial |
$1,373.27
|
| Rate for Payer: HFN Commercial |
$1,419.56
|
| Rate for Payer: Multiplan Commercial |
$1,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$925.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.56
|
| Rate for Payer: Quartz Beloit One Network |
$756.07
|
| Rate for Payer: Quartz Commercial |
$925.80
|
| Rate for Payer: WEA Trust Commercial |
$848.65
|
| Rate for Payer: WPS Commercial |
$1,142.90
|
|
|
STAPLER LINEAR 90MM TLH90/TCT10
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.04 |
| Max. Negotiated Rate |
$6,172.00 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.98
|
| Rate for Payer: Aetna Managed Medicare |
$432.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,002.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.79
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,419.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.46
|
| Rate for Payer: Health EOS Commercial |
$1,373.27
|
| Rate for Payer: HFN Commercial |
$1,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.25
|
| Rate for Payer: Multiplan Commercial |
$1,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$925.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.56
|
| Rate for Payer: Quartz Beloit One Network |
$756.07
|
| Rate for Payer: Quartz Commercial |
$1,002.95
|
| Rate for Payer: Quartz Medicare Advantage |
$925.80
|
| Rate for Payer: The Alliance Commercial |
$6,172.00
|
| Rate for Payer: WEA Trust Commercial |
$848.65
|
| Rate for Payer: WPS Commercial |
$1,142.90
|
|
|
STAPLER LINEAR (BLUE) 30MM TX30B
|
Facility
|
IP
|
$1,382.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.18 |
| Max. Negotiated Rate |
$1,271.44 |
| Rate for Payer: Aetna Commercial |
$1,243.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.46
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$1,271.44
|
| Rate for Payer: Health EOS Commercial |
$1,229.98
|
| Rate for Payer: HFN Commercial |
$1,271.44
|
| Rate for Payer: Multiplan Commercial |
$1,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.44
|
| Rate for Payer: Quartz Beloit One Network |
$677.18
|
| Rate for Payer: Quartz Commercial |
$829.20
|
| Rate for Payer: WEA Trust Commercial |
$760.10
|
| Rate for Payer: WPS Commercial |
$1,023.65
|
|
|
STAPLER LINEAR (BLUE) 30MM TX30B
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.96 |
| Max. Negotiated Rate |
$5,528.00 |
| Rate for Payer: Aetna Commercial |
$1,243.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.52
|
| Rate for Payer: Aetna Managed Medicare |
$386.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.46
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$1,271.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.37
|
| Rate for Payer: Health EOS Commercial |
$1,229.98
|
| Rate for Payer: HFN Commercial |
$1,271.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,036.50
|
| Rate for Payer: Multiplan Commercial |
$1,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.44
|
| Rate for Payer: Quartz Beloit One Network |
$677.18
|
| Rate for Payer: Quartz Commercial |
$898.30
|
| Rate for Payer: Quartz Medicare Advantage |
$829.20
|
| Rate for Payer: The Alliance Commercial |
$5,528.00
|
| Rate for Payer: WEA Trust Commercial |
$760.10
|
| Rate for Payer: WPS Commercial |
$1,023.65
|
|
|
STAPLER LINEAR (BLUE) 60MM TX60B
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.49 |
| Max. Negotiated Rate |
$1,288.92 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$840.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$840.60
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
STAPLER LINEAR (BLUE) 60MM TX60B
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.28 |
| Max. Negotiated Rate |
$5,604.00 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Aetna Managed Medicare |
$392.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.75
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$840.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$910.65
|
| Rate for Payer: Quartz Medicare Advantage |
$840.60
|
| Rate for Payer: The Alliance Commercial |
$5,604.00
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
STAPLER LINEAR CUTTER 55MM TLC55
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.96 |
| Max. Negotiated Rate |
$5,728.00 |
| Rate for Payer: Aetna Commercial |
$1,288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,231.52
|
| Rate for Payer: Aetna Managed Medicare |
$400.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$930.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$687.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.96
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$1,317.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$801.35
|
| Rate for Payer: Health EOS Commercial |
$1,274.48
|
| Rate for Payer: HFN Commercial |
$1,317.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,074.00
|
| Rate for Payer: Multiplan Commercial |
$1,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$859.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.44
|
| Rate for Payer: Quartz Beloit One Network |
$701.68
|
| Rate for Payer: Quartz Commercial |
$930.80
|
| Rate for Payer: Quartz Medicare Advantage |
$859.20
|
| Rate for Payer: The Alliance Commercial |
$5,728.00
|
| Rate for Payer: WEA Trust Commercial |
$787.60
|
| Rate for Payer: WPS Commercial |
$1,060.68
|
|
|
STAPLER LINEAR CUTTER 55MM TLC55
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.68 |
| Max. Negotiated Rate |
$1,317.44 |
| Rate for Payer: Aetna Commercial |
$1,288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,231.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.96
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$1,317.44
|
| Rate for Payer: Health EOS Commercial |
$1,274.48
|
| Rate for Payer: HFN Commercial |
$1,317.44
|
| Rate for Payer: Multiplan Commercial |
$1,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$859.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.44
|
| Rate for Payer: Quartz Beloit One Network |
$701.68
|
| Rate for Payer: Quartz Commercial |
$859.20
|
| Rate for Payer: WEA Trust Commercial |
$787.60
|
| Rate for Payer: WPS Commercial |
$1,060.68
|
|
|
STAPLER LINEAR CUTTER 75MM TLC75
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.20 |
| Max. Negotiated Rate |
$1,637.60 |
| Rate for Payer: Aetna Commercial |
$1,602.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,530.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.40
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$1,637.60
|
| Rate for Payer: Health EOS Commercial |
$1,584.20
|
| Rate for Payer: HFN Commercial |
$1,637.60
|
| Rate for Payer: Multiplan Commercial |
$1,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,637.60
|
| Rate for Payer: Quartz Beloit One Network |
$872.20
|
| Rate for Payer: Quartz Commercial |
$1,068.00
|
| Rate for Payer: WEA Trust Commercial |
$979.00
|
| Rate for Payer: WPS Commercial |
$1,318.45
|
|
|
STAPLER LINEAR CUTTER 75MM TLC75
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.40 |
| Max. Negotiated Rate |
$7,120.00 |
| Rate for Payer: Aetna Commercial |
$1,602.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,530.80
|
| Rate for Payer: Aetna Managed Medicare |
$498.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.40
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$1,637.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.09
|
| Rate for Payer: Health EOS Commercial |
$1,584.20
|
| Rate for Payer: HFN Commercial |
$1,637.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,335.00
|
| Rate for Payer: Multiplan Commercial |
$1,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,637.60
|
| Rate for Payer: Quartz Beloit One Network |
$872.20
|
| Rate for Payer: Quartz Commercial |
$1,157.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.00
|
| Rate for Payer: The Alliance Commercial |
$7,120.00
|
| Rate for Payer: WEA Trust Commercial |
$979.00
|
| Rate for Payer: WPS Commercial |
$1,318.45
|
|
|
STAPLER LINEAR VASCULAR 30MM TX30V
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.02 |
| Max. Negotiated Rate |
$1,378.16 |
| Rate for Payer: Aetna Commercial |
$1,348.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.94
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,378.16
|
| Rate for Payer: Health EOS Commercial |
$1,333.22
|
| Rate for Payer: HFN Commercial |
$1,378.16
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$898.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.16
|
| Rate for Payer: Quartz Beloit One Network |
$734.02
|
| Rate for Payer: Quartz Commercial |
$898.80
|
| Rate for Payer: WEA Trust Commercial |
$823.90
|
| Rate for Payer: WPS Commercial |
$1,109.57
|
|
|
STAPLER LINEAR VASCULAR 30MM TX30V
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.44 |
| Max. Negotiated Rate |
$5,992.00 |
| Rate for Payer: Aetna Commercial |
$1,348.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.28
|
| Rate for Payer: Aetna Managed Medicare |
$419.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$973.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.94
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,378.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.28
|
| Rate for Payer: Health EOS Commercial |
$1,333.22
|
| Rate for Payer: HFN Commercial |
$1,378.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,123.50
|
| Rate for Payer: Multiplan Commercial |
$1,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$898.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.16
|
| Rate for Payer: Quartz Beloit One Network |
$734.02
|
| Rate for Payer: Quartz Commercial |
$973.70
|
| Rate for Payer: Quartz Medicare Advantage |
$898.80
|
| Rate for Payer: The Alliance Commercial |
$5,992.00
|
| Rate for Payer: WEA Trust Commercial |
$823.90
|
| Rate for Payer: WPS Commercial |
$1,109.57
|
|
|
STAPLER RELOAD 30-3.5 SNGL USE
|
Facility
|
IP
|
$1,119.00
|
|
| Hospital Charge Code |
2962997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.31 |
| Max. Negotiated Rate |
$1,029.48 |
| Rate for Payer: Aetna Commercial |
$1,007.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.07
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,029.48
|
| Rate for Payer: Health EOS Commercial |
$995.91
|
| Rate for Payer: HFN Commercial |
$1,029.48
|
| Rate for Payer: Multiplan Commercial |
$895.20
|
| Rate for Payer: NAPHCARE Commercial |
$671.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.48
|
| Rate for Payer: Quartz Beloit One Network |
$548.31
|
| Rate for Payer: Quartz Commercial |
$671.40
|
| Rate for Payer: WEA Trust Commercial |
$615.45
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
|
STAPLER RELOAD 30-3.5 SNGL USE
|
Facility
|
OP
|
$1,119.00
|
|
| Hospital Charge Code |
2962997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$1,007.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.34
|
| Rate for Payer: Aetna Managed Medicare |
$313.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$727.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$559.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$537.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.07
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,029.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$626.19
|
| Rate for Payer: Health EOS Commercial |
$995.91
|
| Rate for Payer: HFN Commercial |
$1,029.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$839.25
|
| Rate for Payer: Multiplan Commercial |
$895.20
|
| Rate for Payer: NAPHCARE Commercial |
$671.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.48
|
| Rate for Payer: Quartz Beloit One Network |
$548.31
|
| Rate for Payer: Quartz Commercial |
$727.35
|
| Rate for Payer: Quartz Medicare Advantage |
$671.40
|
| Rate for Payer: The Alliance Commercial |
$4,476.00
|
| Rate for Payer: WEA Trust Commercial |
$615.45
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
|
STAPLER RELOAD 30-V3 SNGL USE
|
Facility
|
OP
|
$1,698.00
|
|
| Hospital Charge Code |
2969232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.44 |
| Max. Negotiated Rate |
$6,792.00 |
| Rate for Payer: Aetna Commercial |
$1,528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,460.28
|
| Rate for Payer: Aetna Managed Medicare |
$475.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$849.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$815.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.94
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$1,562.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$950.20
|
| Rate for Payer: Health EOS Commercial |
$1,511.22
|
| Rate for Payer: HFN Commercial |
$1,562.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,273.50
|
| Rate for Payer: Multiplan Commercial |
$1,358.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,562.16
|
| Rate for Payer: Quartz Beloit One Network |
$832.02
|
| Rate for Payer: Quartz Commercial |
$1,103.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.80
|
| Rate for Payer: The Alliance Commercial |
$6,792.00
|
| Rate for Payer: WEA Trust Commercial |
$933.90
|
| Rate for Payer: WPS Commercial |
$1,257.71
|
|
|
STAPLER RELOAD 30-V3 SNGL USE
|
Facility
|
IP
|
$1,698.00
|
|
| Hospital Charge Code |
2969232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.02 |
| Max. Negotiated Rate |
$1,562.16 |
| Rate for Payer: Aetna Commercial |
$1,528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,460.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.94
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$1,562.16
|
| Rate for Payer: Health EOS Commercial |
$1,511.22
|
| Rate for Payer: HFN Commercial |
$1,562.16
|
| Rate for Payer: Multiplan Commercial |
$1,358.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,562.16
|
| Rate for Payer: Quartz Beloit One Network |
$832.02
|
| Rate for Payer: Quartz Commercial |
$1,018.80
|
| Rate for Payer: WEA Trust Commercial |
$933.90
|
| Rate for Payer: WPS Commercial |
$1,257.71
|
|
|
STAPLER RELOAD 45MM BLUE 6R45B
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5306760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.57 |
| Max. Negotiated Rate |
$1,465.56 |
| Rate for Payer: Aetna Commercial |
$1,433.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.29
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,465.56
|
| Rate for Payer: Health EOS Commercial |
$1,417.77
|
| Rate for Payer: HFN Commercial |
$1,465.56
|
| Rate for Payer: Multiplan Commercial |
$1,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$955.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.56
|
| Rate for Payer: Quartz Beloit One Network |
$780.57
|
| Rate for Payer: Quartz Commercial |
$955.80
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
