|
STAPLER RELOAD 45MM BLUE 6R45B
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5306760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.04 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna Commercial |
$1,433.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.98
|
| Rate for Payer: Aetna Managed Medicare |
$446.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,035.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.64
|
| 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: Dean Health DHI/DHP/ASO |
$891.44
|
| Rate for Payer: Health EOS Commercial |
$1,417.77
|
| Rate for Payer: HFN Commercial |
$1,465.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.75
|
| 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 |
$1,035.45
|
| Rate for Payer: Quartz Medicare Advantage |
$955.80
|
| Rate for Payer: The Alliance Commercial |
$6,372.00
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
|
STAPLER RELOAD 45MM VASCULAR WHITE TR-45W
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2962946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
STAPLER RELOAD 45MM VASCULAR WHITE TR-45W
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2962946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
STAPLER RELOAD 60-3.5 SNGL USE
|
Facility
|
OP
|
$1,186.00
|
|
| Hospital Charge Code |
2962987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.08 |
| Max. Negotiated Rate |
$4,744.00 |
| Rate for Payer: Aetna Commercial |
$1,067.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,019.96
|
| Rate for Payer: Aetna Managed Medicare |
$332.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$770.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$593.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$569.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.58
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,091.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$663.69
|
| Rate for Payer: Health EOS Commercial |
$1,055.54
|
| Rate for Payer: HFN Commercial |
$1,091.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$889.50
|
| Rate for Payer: Multiplan Commercial |
$948.80
|
| Rate for Payer: NAPHCARE Commercial |
$711.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,091.12
|
| Rate for Payer: Quartz Beloit One Network |
$581.14
|
| Rate for Payer: Quartz Commercial |
$770.90
|
| Rate for Payer: Quartz Medicare Advantage |
$711.60
|
| Rate for Payer: The Alliance Commercial |
$4,744.00
|
| Rate for Payer: WEA Trust Commercial |
$652.30
|
| Rate for Payer: WPS Commercial |
$878.47
|
|
|
STAPLER RELOAD 60-3.5 SNGL USE
|
Facility
|
IP
|
$1,186.00
|
|
| Hospital Charge Code |
2962987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.14 |
| Max. Negotiated Rate |
$1,091.12 |
| Rate for Payer: Aetna Commercial |
$1,067.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,019.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.58
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,091.12
|
| Rate for Payer: Health EOS Commercial |
$1,055.54
|
| Rate for Payer: HFN Commercial |
$1,091.12
|
| Rate for Payer: Multiplan Commercial |
$948.80
|
| Rate for Payer: NAPHCARE Commercial |
$711.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,091.12
|
| Rate for Payer: Quartz Beloit One Network |
$581.14
|
| Rate for Payer: Quartz Commercial |
$711.60
|
| Rate for Payer: WEA Trust Commercial |
$652.30
|
| Rate for Payer: WPS Commercial |
$878.47
|
|
|
STAPLER RELOAD 60-3.8
|
Facility
|
OP
|
$2,643.00
|
|
| Hospital Charge Code |
2962963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.04 |
| Max. Negotiated Rate |
$10,572.00 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,272.98
|
| Rate for Payer: Aetna Managed Medicare |
$740.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,717.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,321.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,268.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.79
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna Commercial |
$2,431.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,479.02
|
| Rate for Payer: Health EOS Commercial |
$2,352.27
|
| Rate for Payer: HFN Commercial |
$2,431.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,982.25
|
| Rate for Payer: Multiplan Commercial |
$2,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,585.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,431.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.07
|
| Rate for Payer: Quartz Commercial |
$1,717.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,585.80
|
| Rate for Payer: The Alliance Commercial |
$10,572.00
|
| Rate for Payer: WEA Trust Commercial |
$1,453.65
|
| Rate for Payer: WPS Commercial |
$1,957.67
|
|
|
STAPLER RELOAD 60-3.8
|
Facility
|
IP
|
$2,643.00
|
|
| Hospital Charge Code |
2962963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.07 |
| Max. Negotiated Rate |
$2,431.56 |
| Rate for Payer: Aetna Commercial |
$2,378.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,272.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.79
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna Commercial |
$2,431.56
|
| Rate for Payer: Health EOS Commercial |
$2,352.27
|
| Rate for Payer: HFN Commercial |
$2,431.56
|
| Rate for Payer: Multiplan Commercial |
$2,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,585.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,431.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.07
|
| Rate for Payer: Quartz Commercial |
$1,585.80
|
| Rate for Payer: WEA Trust Commercial |
$1,453.65
|
| Rate for Payer: WPS Commercial |
$1,957.67
|
|
|
STAPLER RELOAD 60-4.8 SNGL USE
|
Facility
|
IP
|
$997.00
|
|
| Hospital Charge Code |
2962985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.53 |
| Max. Negotiated Rate |
$917.24 |
| Rate for Payer: Aetna Commercial |
$897.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.41
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cigna Commercial |
$917.24
|
| Rate for Payer: Health EOS Commercial |
$887.33
|
| Rate for Payer: HFN Commercial |
$917.24
|
| Rate for Payer: Multiplan Commercial |
$797.60
|
| Rate for Payer: NAPHCARE Commercial |
$598.20
|
| Rate for Payer: Preferred Network Access Commercial |
$917.24
|
| Rate for Payer: Quartz Beloit One Network |
$488.53
|
| Rate for Payer: Quartz Commercial |
$598.20
|
| Rate for Payer: WEA Trust Commercial |
$548.35
|
| Rate for Payer: WPS Commercial |
$738.48
|
|
|
STAPLER RELOAD 60-4.8 SNGL USE
|
Facility
|
OP
|
$997.00
|
|
| Hospital Charge Code |
2962985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.16 |
| Max. Negotiated Rate |
$3,988.00 |
| Rate for Payer: Aetna Commercial |
$897.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.42
|
| Rate for Payer: Aetna Managed Medicare |
$279.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.41
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cigna Commercial |
$917.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.92
|
| Rate for Payer: Health EOS Commercial |
$887.33
|
| Rate for Payer: HFN Commercial |
$917.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.75
|
| Rate for Payer: Multiplan Commercial |
$797.60
|
| Rate for Payer: NAPHCARE Commercial |
$598.20
|
| Rate for Payer: Preferred Network Access Commercial |
$917.24
|
| Rate for Payer: Quartz Beloit One Network |
$488.53
|
| Rate for Payer: Quartz Commercial |
$648.05
|
| Rate for Payer: Quartz Medicare Advantage |
$598.20
|
| Rate for Payer: The Alliance Commercial |
$3,988.00
|
| Rate for Payer: WEA Trust Commercial |
$548.35
|
| Rate for Payer: WPS Commercial |
$738.48
|
|
|
STAPLER RELOAD BLUE 030455
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.44 |
| Max. Negotiated Rate |
$6,592.00 |
| Rate for Payer: Aetna Commercial |
$1,483.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,417.28
|
| Rate for Payer: Aetna Managed Medicare |
$461.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,071.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$824.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$791.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.44
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,516.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$922.22
|
| Rate for Payer: Health EOS Commercial |
$1,466.72
|
| Rate for Payer: HFN Commercial |
$1,516.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: NAPHCARE Commercial |
$988.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,516.16
|
| Rate for Payer: Quartz Beloit One Network |
$807.52
|
| Rate for Payer: Quartz Commercial |
$1,071.20
|
| Rate for Payer: Quartz Medicare Advantage |
$988.80
|
| Rate for Payer: The Alliance Commercial |
$6,592.00
|
| Rate for Payer: WEA Trust Commercial |
$906.40
|
| Rate for Payer: WPS Commercial |
$1,220.67
|
|
|
STAPLER RELOAD BLUE 030455
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$807.52 |
| Max. Negotiated Rate |
$1,516.16 |
| Rate for Payer: Aetna Commercial |
$1,483.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,417.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.44
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,516.16
|
| Rate for Payer: Health EOS Commercial |
$1,466.72
|
| Rate for Payer: HFN Commercial |
$1,516.16
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: NAPHCARE Commercial |
$988.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,516.16
|
| Rate for Payer: Quartz Beloit One Network |
$807.52
|
| Rate for Payer: Quartz Commercial |
$988.80
|
| Rate for Payer: WEA Trust Commercial |
$906.40
|
| Rate for Payer: WPS Commercial |
$1,220.67
|
|
|
STAPLER RELOAD CONTOUR BLUE CR40B/GCR40B
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3376923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,745.87 |
| Max. Negotiated Rate |
$3,277.96 |
| Rate for Payer: Aetna Commercial |
$3,206.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,064.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.39
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,277.96
|
| Rate for Payer: Health EOS Commercial |
$3,171.07
|
| Rate for Payer: HFN Commercial |
$3,277.96
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,137.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,277.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,745.87
|
| Rate for Payer: Quartz Commercial |
$2,137.80
|
| Rate for Payer: WEA Trust Commercial |
$1,959.65
|
| Rate for Payer: WPS Commercial |
$2,639.11
|
|
|
STAPLER RELOAD CONTOUR BLUE CR40B/GCR40B
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3376923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.64 |
| Max. Negotiated Rate |
$14,252.00 |
| Rate for Payer: Aetna Commercial |
$3,206.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,064.18
|
| Rate for Payer: Aetna Managed Medicare |
$997.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,315.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,781.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,710.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.39
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,277.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,993.85
|
| Rate for Payer: Health EOS Commercial |
$3,171.07
|
| Rate for Payer: HFN Commercial |
$3,277.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,672.25
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,137.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,277.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,745.87
|
| Rate for Payer: Quartz Commercial |
$2,315.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,137.80
|
| Rate for Payer: The Alliance Commercial |
$14,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,959.65
|
| Rate for Payer: WPS Commercial |
$2,639.11
|
|
|
STAPLER RELOAD CONTOUR GREEN CR40G/GCR40G
|
Facility
|
IP
|
$3,563.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3376921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,745.87 |
| Max. Negotiated Rate |
$3,277.96 |
| Rate for Payer: Aetna Commercial |
$3,206.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,064.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.39
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,277.96
|
| Rate for Payer: Health EOS Commercial |
$3,171.07
|
| Rate for Payer: HFN Commercial |
$3,277.96
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,137.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,277.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,745.87
|
| Rate for Payer: Quartz Commercial |
$2,137.80
|
| Rate for Payer: WEA Trust Commercial |
$1,959.65
|
| Rate for Payer: WPS Commercial |
$2,639.11
|
|
|
STAPLER RELOAD CONTOUR GREEN CR40G/GCR40G
|
Facility
|
OP
|
$3,563.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3376921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.64 |
| Max. Negotiated Rate |
$14,252.00 |
| Rate for Payer: Aetna Commercial |
$3,206.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,064.18
|
| Rate for Payer: Aetna Managed Medicare |
$997.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,315.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,781.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,710.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.39
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,277.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,993.85
|
| Rate for Payer: Health EOS Commercial |
$3,171.07
|
| Rate for Payer: HFN Commercial |
$3,277.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,672.25
|
| Rate for Payer: Multiplan Commercial |
$2,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,137.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,277.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,745.87
|
| Rate for Payer: Quartz Commercial |
$2,315.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,137.80
|
| Rate for Payer: The Alliance Commercial |
$14,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,959.65
|
| Rate for Payer: WPS Commercial |
$2,639.11
|
|
|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (BLUE) GST45B/ECR45B
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$1,552.96 |
| Rate for Payer: Aetna Commercial |
$1,519.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.64
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,552.96
|
| Rate for Payer: Health EOS Commercial |
$1,502.32
|
| Rate for Payer: HFN Commercial |
$1,552.96
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.96
|
| Rate for Payer: Quartz Beloit One Network |
$827.12
|
| Rate for Payer: Quartz Commercial |
$1,012.80
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (BLUE) GST45B/ECR45B
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$6,752.00 |
| Rate for Payer: Aetna Commercial |
$1,519.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Aetna Managed Medicare |
$472.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,097.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$844.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$810.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.64
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,552.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.60
|
| Rate for Payer: Health EOS Commercial |
$1,502.32
|
| Rate for Payer: HFN Commercial |
$1,552.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,266.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.96
|
| Rate for Payer: Quartz Beloit One Network |
$827.12
|
| Rate for Payer: Quartz Commercial |
$1,097.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.80
|
| Rate for Payer: The Alliance Commercial |
$6,752.00
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (VASCULAR) GST45W/ECR45W
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$1,552.96 |
| Rate for Payer: Aetna Commercial |
$1,519.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.64
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,552.96
|
| Rate for Payer: Health EOS Commercial |
$1,502.32
|
| Rate for Payer: HFN Commercial |
$1,552.96
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.96
|
| Rate for Payer: Quartz Beloit One Network |
$827.12
|
| Rate for Payer: Quartz Commercial |
$1,012.80
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (VASCULAR) GST45W/ECR45W
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$6,752.00 |
| Rate for Payer: Aetna Commercial |
$1,519.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Aetna Managed Medicare |
$472.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,097.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$844.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$810.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.64
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,552.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.60
|
| Rate for Payer: Health EOS Commercial |
$1,502.32
|
| Rate for Payer: HFN Commercial |
$1,552.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,266.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.96
|
| Rate for Payer: Quartz Beloit One Network |
$827.12
|
| Rate for Payer: Quartz Commercial |
$1,097.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.80
|
| Rate for Payer: The Alliance Commercial |
$6,752.00
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
|
STAPLER RELOAD ECHELON FLEX POWERED VASCULAR 35MM VASECR35
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4595663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Aetna Managed Medicare |
$546.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,269.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$976.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,092.90
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.75
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,269.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.80
|
| Rate for Payer: The Alliance Commercial |
$7,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
STAPLER RELOAD ECHELON FLEX POWERED VASCULAR 35MM VASECR35
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4595663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$956.97 |
| Max. Negotiated Rate |
$1,796.76 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,171.80
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
STAPLER RELOAD ECHELON POWERED 60MM (BLUE) GST60B
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4494248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,009.40 |
| Max. Negotiated Rate |
$1,895.20 |
| Rate for Payer: Aetna Commercial |
$1,854.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,771.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.80
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cigna Commercial |
$1,895.20
|
| Rate for Payer: Health EOS Commercial |
$1,833.40
|
| Rate for Payer: HFN Commercial |
$1,895.20
|
| Rate for Payer: Multiplan Commercial |
$1,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,236.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,895.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,009.40
|
| Rate for Payer: Quartz Commercial |
$1,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,133.00
|
| Rate for Payer: WPS Commercial |
$1,525.84
|
|
|
STAPLER RELOAD ECHELON POWERED 60MM (BLUE) GST60B
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4494248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.80 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Aetna Commercial |
$1,854.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,771.60
|
| Rate for Payer: Aetna Managed Medicare |
$576.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,339.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,030.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.80
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cigna Commercial |
$1,895.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.78
|
| Rate for Payer: Health EOS Commercial |
$1,833.40
|
| Rate for Payer: HFN Commercial |
$1,895.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,545.00
|
| Rate for Payer: Multiplan Commercial |
$1,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,236.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,895.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,009.40
|
| Rate for Payer: Quartz Commercial |
$1,339.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,236.00
|
| Rate for Payer: The Alliance Commercial |
$8,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,133.00
|
| Rate for Payer: WPS Commercial |
$1,525.84
|
|
|
STAPLER RELOAD ENDOCUTTER 45MM (GREEN) GST45G
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3697500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$1,552.96 |
| Rate for Payer: Aetna Commercial |
$1,519.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.64
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,552.96
|
| Rate for Payer: Health EOS Commercial |
$1,502.32
|
| Rate for Payer: HFN Commercial |
$1,552.96
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.96
|
| Rate for Payer: Quartz Beloit One Network |
$827.12
|
| Rate for Payer: Quartz Commercial |
$1,012.80
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
|
STAPLER RELOAD ENDOCUTTER 45MM (GREEN) GST45G
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3697500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$6,752.00 |
| Rate for Payer: Aetna Commercial |
$1,519.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Aetna Managed Medicare |
$472.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,097.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$844.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$810.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.64
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,552.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.60
|
| Rate for Payer: Health EOS Commercial |
$1,502.32
|
| Rate for Payer: HFN Commercial |
$1,552.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,266.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.96
|
| Rate for Payer: Quartz Beloit One Network |
$827.12
|
| Rate for Payer: Quartz Commercial |
$1,097.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.80
|
| Rate for Payer: The Alliance Commercial |
$6,752.00
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
