|
STAPLER EEA 21MM EEA21/CEEA21 111983
|
Facility
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2962880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.96 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,303.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,027.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,328.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,606.06
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,492.75
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$3,027.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,794.20
|
| Rate for Payer: The Alliance Commercial |
$18,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
STAPLER EEA 21MM EEA21/CEEA21 111983
|
Facility
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2962880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.93 |
| Max. Negotiated Rate |
$4,284.44 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$2,794.20
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
STAPLER EEA 25MM - 4.8MM CIRCULAR EEA25
|
Facility
IP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.64 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER EEA 25MM - 4.8MM CIRCULAR EEA25
|
Facility
OP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,143.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,321.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,706.23
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,627.00
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$3,143.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER EEA 28MM - 4.8MM CIRCULAR EEA28
|
Facility
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,580.00
|
| Rate for Payer: Aetna Managed Medicare |
$840.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,950.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,590.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,760.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,678.80
|
| Rate for Payer: Health EOS Commercial |
$2,670.00
|
| Rate for Payer: HFN Commercial |
$2,760.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.00
|
| Rate for Payer: Multiplan Commercial |
$2,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,760.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.00
|
| Rate for Payer: Quartz Commercial |
$1,950.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,800.00
|
| Rate for Payer: WEA Trust Commercial |
$1,650.00
|
| Rate for Payer: WPS Commercial |
$2,222.10
|
|
|
STAPLER EEA 28MM - 4.8MM CIRCULAR EEA28
|
Facility
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,590.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,760.00
|
| Rate for Payer: Health EOS Commercial |
$2,670.00
|
| Rate for Payer: HFN Commercial |
$2,760.00
|
| Rate for Payer: Multiplan Commercial |
$2,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,760.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.00
|
| Rate for Payer: Quartz Commercial |
$1,800.00
|
| Rate for Payer: WEA Trust Commercial |
$1,650.00
|
| Rate for Payer: WPS Commercial |
$2,222.10
|
|
|
STAPLER EEA 31MM - 4.8MM CIRCULAR EEA31
|
Facility
IP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.64 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER EEA 31MM - 4.8MM CIRCULAR EEA31
|
Facility
OP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,143.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,321.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,706.23
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,627.00
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$3,143.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER ENDO GIA 12MM SNGL USE
|
Facility
IP
|
$3,517.00
|
|
| Hospital Charge Code |
2962965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,723.33 |
| Max. Negotiated Rate |
$3,235.64 |
| Rate for Payer: Aetna Commercial |
$3,165.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.01
|
| Rate for Payer: Cash Price |
$1,055.10
|
| Rate for Payer: Cigna Commercial |
$3,235.64
|
| Rate for Payer: Health EOS Commercial |
$3,130.13
|
| Rate for Payer: HFN Commercial |
$3,235.64
|
| Rate for Payer: Multiplan Commercial |
$2,813.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,110.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,235.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.33
|
| Rate for Payer: Quartz Commercial |
$2,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,934.35
|
| Rate for Payer: WPS Commercial |
$2,605.04
|
|
|
STAPLER ENDO GIA 12MM SNGL USE
|
Facility
OP
|
$3,517.00
|
|
| Hospital Charge Code |
2962965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.76 |
| Max. Negotiated Rate |
$14,068.00 |
| Rate for Payer: Aetna Commercial |
$3,165.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,024.62
|
| Rate for Payer: Aetna Managed Medicare |
$984.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,286.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,758.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,688.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.01
|
| Rate for Payer: Cash Price |
$1,055.10
|
| Rate for Payer: Cigna Commercial |
$3,235.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,968.11
|
| Rate for Payer: Health EOS Commercial |
$3,130.13
|
| Rate for Payer: HFN Commercial |
$3,235.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,637.75
|
| Rate for Payer: Multiplan Commercial |
$2,813.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,110.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,235.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.33
|
| Rate for Payer: Quartz Commercial |
$2,286.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,110.20
|
| Rate for Payer: The Alliance Commercial |
$14,068.00
|
| Rate for Payer: WEA Trust Commercial |
$1,934.35
|
| Rate for Payer: WPS Commercial |
$2,605.04
|
|
|
STAPLER ENDO HERNIA 12MM 173052
|
Facility
IP
|
$3,832.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,877.68 |
| Max. Negotiated Rate |
$3,525.44 |
| Rate for Payer: Aetna Commercial |
$3,448.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,030.96
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,525.44
|
| Rate for Payer: Health EOS Commercial |
$3,410.48
|
| Rate for Payer: HFN Commercial |
$3,525.44
|
| Rate for Payer: Multiplan Commercial |
$3,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,299.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,525.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.68
|
| Rate for Payer: Quartz Commercial |
$2,299.20
|
| Rate for Payer: WEA Trust Commercial |
$2,107.60
|
| Rate for Payer: WPS Commercial |
$2,838.36
|
|
|
STAPLER ENDO HERNIA 12MM 173052
|
Facility
OP
|
$3,832.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.96 |
| Max. Negotiated Rate |
$3,525.44 |
| Rate for Payer: Aetna Commercial |
$3,448.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,295.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,072.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,490.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,916.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,839.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,030.96
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,525.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,144.39
|
| Rate for Payer: Health EOS Commercial |
$3,410.48
|
| Rate for Payer: HFN Commercial |
$3,525.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,874.00
|
| Rate for Payer: Multiplan Commercial |
$3,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,299.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,525.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.68
|
| Rate for Payer: Quartz Commercial |
$2,490.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,299.20
|
| Rate for Payer: WEA Trust Commercial |
$2,107.60
|
| Rate for Payer: WPS Commercial |
$2,838.36
|
|
|
STAPLER HANDLE ENDOGIA ULTRA SHORT EGIAUSHORT
|
Facility
IP
|
$3,412.00
|
|
| Hospital Charge Code |
5547296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,671.88 |
| Max. Negotiated Rate |
$3,139.04 |
| Rate for Payer: Aetna Commercial |
$3,070.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.36
|
| Rate for Payer: Cash Price |
$1,023.60
|
| Rate for Payer: Cigna Commercial |
$3,139.04
|
| Rate for Payer: Health EOS Commercial |
$3,036.68
|
| Rate for Payer: HFN Commercial |
$3,139.04
|
| Rate for Payer: Multiplan Commercial |
$2,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,671.88
|
| Rate for Payer: Quartz Commercial |
$2,047.20
|
| Rate for Payer: WEA Trust Commercial |
$1,876.60
|
| Rate for Payer: WPS Commercial |
$2,527.27
|
|
|
STAPLER HANDLE ENDOGIA ULTRA SHORT EGIAUSHORT
|
Facility
OP
|
$3,412.00
|
|
| Hospital Charge Code |
5547296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.36 |
| Max. Negotiated Rate |
$13,648.00 |
| Rate for Payer: Aetna Commercial |
$3,070.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,934.32
|
| Rate for Payer: Aetna Managed Medicare |
$955.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,217.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,706.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,637.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.36
|
| Rate for Payer: Cash Price |
$1,023.60
|
| Rate for Payer: Cigna Commercial |
$3,139.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,909.36
|
| Rate for Payer: Health EOS Commercial |
$3,036.68
|
| Rate for Payer: HFN Commercial |
$3,139.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,559.00
|
| Rate for Payer: Multiplan Commercial |
$2,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,671.88
|
| Rate for Payer: Quartz Commercial |
$2,217.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,047.20
|
| Rate for Payer: The Alliance Commercial |
$13,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,876.60
|
| Rate for Payer: WPS Commercial |
$2,527.27
|
|
|
STAPLER HANDLE ENDOGIA ULTRA STD EGIAUSTND
|
Facility
OP
|
$3,490.00
|
|
| Hospital Charge Code |
4462803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$977.20 |
| Max. Negotiated Rate |
$13,960.00 |
| Rate for Payer: Aetna Commercial |
$3,141.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,001.40
|
| Rate for Payer: Aetna Managed Medicare |
$977.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,268.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,745.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,675.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,849.70
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$3,210.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,953.00
|
| Rate for Payer: Health EOS Commercial |
$3,106.10
|
| Rate for Payer: HFN Commercial |
$3,210.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,617.50
|
| Rate for Payer: Multiplan Commercial |
$2,792.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,094.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,210.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.10
|
| Rate for Payer: Quartz Commercial |
$2,268.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,094.00
|
| Rate for Payer: The Alliance Commercial |
$13,960.00
|
| Rate for Payer: WEA Trust Commercial |
$1,919.50
|
| Rate for Payer: WPS Commercial |
$2,585.04
|
|
|
STAPLER HANDLE ENDOGIA ULTRA STD EGIAUSTND
|
Facility
IP
|
$3,490.00
|
|
| Hospital Charge Code |
4462803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,710.10 |
| Max. Negotiated Rate |
$3,210.80 |
| Rate for Payer: Aetna Commercial |
$3,141.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,849.70
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$3,210.80
|
| Rate for Payer: Health EOS Commercial |
$3,106.10
|
| Rate for Payer: HFN Commercial |
$3,210.80
|
| Rate for Payer: Multiplan Commercial |
$2,792.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,094.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,210.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.10
|
| Rate for Payer: Quartz Commercial |
$2,094.00
|
| Rate for Payer: WEA Trust Commercial |
$1,919.50
|
| Rate for Payer: WPS Commercial |
$2,585.04
|
|
|
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: 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
OP
|
$1,977.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.56 |
| 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: 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: WEA Trust Commercial |
$1,087.35
|
| Rate for Payer: WPS Commercial |
$1,464.36
|
|
|
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: 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 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 |
$1,585.16 |
| 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: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
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: 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 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 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: 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 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: 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
|
|
