|
STAPLER ECHELON CIRCULAR POWERED EEA 23MM CDH23P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5729637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,426.72 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$2,971.49
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 23MM CDH23P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5729637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.69 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,386.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,219.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,476.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,377.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,771.48
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,714.36
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,971.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$3,219.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,971.49
|
| Rate for Payer: The Alliance Commercial |
$2,476.24
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 25MM CDH25P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5729638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.69 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,386.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,219.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,476.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,377.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,771.48
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,714.36
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,971.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$3,219.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,971.49
|
| Rate for Payer: The Alliance Commercial |
$2,476.24
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 25MM CDH25P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5729638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,426.72 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$2,971.49
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 29MM CDH29P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5685755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.69 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,386.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,219.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,476.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,377.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,771.48
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,714.36
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,971.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$3,219.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,971.49
|
| Rate for Payer: The Alliance Commercial |
$2,476.24
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 29MM CDH29P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5685755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,426.72 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$2,971.49
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 31MM CDH31P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5729639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.69 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,386.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,219.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,476.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,377.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,771.48
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,714.36
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,971.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$3,219.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,971.49
|
| Rate for Payer: The Alliance Commercial |
$2,476.24
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 31MM CDH31P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5729639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,426.72 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: Aetna Commercial |
$4,457.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,259.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,624.81
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,556.28
|
| Rate for Payer: Health EOS Commercial |
$4,407.71
|
| Rate for Payer: HFN Commercial |
$4,556.28
|
| Rate for Payer: Multiplan Commercial |
$3,961.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.72
|
| Rate for Payer: Quartz Commercial |
$2,971.49
|
| Rate for Payer: WEA Trust Commercial |
$2,723.86
|
| Rate for Payer: WPS Commercial |
$3,668.17
|
|
|
STAPLER ECHELON ENDOCUTTER POWERED 45MM PSEE45A / ECH45S
|
Facility
|
IP
|
$3,526.00
|
|
| Hospital Charge Code |
3633513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,796.85 |
| Max. Negotiated Rate |
$3,373.68 |
| Rate for Payer: Aetna Commercial |
$3,300.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,153.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,943.53
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Cigna Commercial |
$3,373.68
|
| Rate for Payer: Health EOS Commercial |
$3,263.67
|
| Rate for Payer: HFN Commercial |
$3,373.68
|
| Rate for Payer: Multiplan Commercial |
$2,933.63
|
| Rate for Payer: Preferred Network Access Commercial |
$3,373.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,796.85
|
| Rate for Payer: Quartz Commercial |
$2,200.22
|
| Rate for Payer: WEA Trust Commercial |
$2,016.87
|
| Rate for Payer: WPS Commercial |
$2,716.08
|
|
|
STAPLER ECHELON ENDOCUTTER POWERED 45MM PSEE45A / ECH45S
|
Facility
|
OP
|
$3,526.00
|
|
| Hospital Charge Code |
3633513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,026.77 |
| Max. Negotiated Rate |
$3,373.68 |
| Rate for Payer: Aetna Commercial |
$3,300.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,153.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,026.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,383.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,833.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,943.53
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Cigna Commercial |
$3,373.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,052.13
|
| Rate for Payer: Health EOS Commercial |
$3,263.67
|
| Rate for Payer: HFN Commercial |
$3,373.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,750.28
|
| Rate for Payer: Multiplan Commercial |
$2,933.63
|
| Rate for Payer: NAPHCARE Commercial |
$2,200.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,373.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,796.85
|
| Rate for Payer: Quartz Commercial |
$2,383.58
|
| Rate for Payer: Quartz Medicare Advantage |
$2,200.22
|
| Rate for Payer: The Alliance Commercial |
$1,833.52
|
| Rate for Payer: WEA Trust Commercial |
$2,016.87
|
| Rate for Payer: WPS Commercial |
$2,716.08
|
|
|
STAPLER ECHELON POWERED 60MM PSEE60A
|
Facility
|
OP
|
$3,912.00
|
|
| Hospital Charge Code |
4494247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,139.17 |
| Max. Negotiated Rate |
$3,743.00 |
| Rate for Payer: Aetna Commercial |
$3,661.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,498.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,139.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,644.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,034.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,952.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,156.29
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cigna Commercial |
$3,743.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,276.78
|
| Rate for Payer: Health EOS Commercial |
$3,620.95
|
| Rate for Payer: HFN Commercial |
$3,743.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,051.36
|
| Rate for Payer: Multiplan Commercial |
$3,254.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,441.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,743.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,993.56
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: Quartz Medicare Advantage |
$2,441.09
|
| Rate for Payer: The Alliance Commercial |
$2,034.24
|
| Rate for Payer: WEA Trust Commercial |
$2,237.66
|
| Rate for Payer: WPS Commercial |
$3,013.41
|
|
|
STAPLER ECHELON POWERED 60MM PSEE60A
|
Facility
|
IP
|
$3,912.00
|
|
| Hospital Charge Code |
4494247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,993.56 |
| Max. Negotiated Rate |
$3,743.00 |
| Rate for Payer: Aetna Commercial |
$3,661.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,498.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,156.29
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cigna Commercial |
$3,743.00
|
| Rate for Payer: Health EOS Commercial |
$3,620.95
|
| Rate for Payer: HFN Commercial |
$3,743.00
|
| Rate for Payer: Multiplan Commercial |
$3,254.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,743.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,993.56
|
| Rate for Payer: Quartz Commercial |
$2,441.09
|
| Rate for Payer: WEA Trust Commercial |
$2,237.66
|
| Rate for Payer: WPS Commercial |
$3,013.41
|
|
|
STAPLER ECHELON POWERED VASCULAR 35MM PVE35A
|
Facility
|
IP
|
$3,396.00
|
|
| Hospital Charge Code |
4595662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,730.60 |
| Max. Negotiated Rate |
$3,249.29 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,119.10
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
STAPLER ECHELON POWERED VASCULAR 35MM PVE35A
|
Facility
|
OP
|
$3,396.00
|
|
| Hospital Charge Code |
4595662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$988.92 |
| Max. Negotiated Rate |
$3,249.29 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Aetna Managed Medicare |
$988.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,295.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,765.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,695.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,976.47
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,648.88
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,119.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,295.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,119.10
|
| Rate for Payer: The Alliance Commercial |
$1,765.92
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
STAPLER EEA 21MM EEA21/CEEA21 111983
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2962880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
STAPLER EEA 21MM EEA21/CEEA21 111983
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2962880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
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 |
$2,464.43 |
| Max. Negotiated Rate |
$4,627.08 |
| Rate for Payer: Aetna Commercial |
$4,526.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.60
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,627.08
|
| Rate for Payer: Health EOS Commercial |
$4,476.20
|
| Rate for Payer: HFN Commercial |
$4,627.08
|
| Rate for Payer: Multiplan Commercial |
$4,023.55
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.43
|
| Rate for Payer: Quartz Commercial |
$3,017.66
|
| Rate for Payer: WEA Trust Commercial |
$2,766.19
|
| Rate for Payer: WPS Commercial |
$3,725.17
|
|
|
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 |
$1,408.24 |
| Max. Negotiated Rate |
$4,627.08 |
| Rate for Payer: Aetna Commercial |
$4,526.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,408.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,269.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,414.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.60
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,627.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,814.55
|
| Rate for Payer: Health EOS Commercial |
$4,476.20
|
| Rate for Payer: HFN Commercial |
$4,627.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,772.08
|
| Rate for Payer: Multiplan Commercial |
$4,023.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,017.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.43
|
| Rate for Payer: Quartz Commercial |
$3,269.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,017.66
|
| Rate for Payer: The Alliance Commercial |
$2,514.72
|
| Rate for Payer: WEA Trust Commercial |
$2,766.19
|
| Rate for Payer: WPS Commercial |
$3,725.17
|
|
|
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 |
$1,528.80 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,808.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,683.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,653.60
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,870.40
|
| Rate for Payer: Health EOS Commercial |
$2,776.80
|
| Rate for Payer: HFN Commercial |
$2,870.40
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,870.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,528.80
|
| Rate for Payer: Quartz Commercial |
$1,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,716.00
|
| Rate for Payer: WPS Commercial |
$2,310.90
|
|
|
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 |
$873.60 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,808.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,683.20
|
| Rate for Payer: Aetna Managed Medicare |
$873.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,028.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,560.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,497.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,653.60
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,870.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,746.00
|
| Rate for Payer: Health EOS Commercial |
$2,776.80
|
| Rate for Payer: HFN Commercial |
$2,870.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.00
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,872.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,870.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,528.80
|
| Rate for Payer: Quartz Commercial |
$2,028.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,872.00
|
| Rate for Payer: The Alliance Commercial |
$1,560.00
|
| Rate for Payer: WEA Trust Commercial |
$1,716.00
|
| Rate for Payer: WPS Commercial |
$2,310.90
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE BLACK TRIEEA28XT
|
Facility
|
IP
|
$7,525.00
|
|
| Hospital Charge Code |
5563652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,834.74 |
| Max. Negotiated Rate |
$7,199.92 |
| Rate for Payer: Aetna Commercial |
$7,043.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,730.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,147.78
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$7,199.92
|
| Rate for Payer: Health EOS Commercial |
$6,965.14
|
| Rate for Payer: HFN Commercial |
$7,199.92
|
| Rate for Payer: Multiplan Commercial |
$6,260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,199.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,834.74
|
| Rate for Payer: Quartz Commercial |
$4,695.60
|
| Rate for Payer: WEA Trust Commercial |
$4,304.30
|
| Rate for Payer: WPS Commercial |
$5,796.51
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE BLACK TRIEEA28XT
|
Facility
|
OP
|
$7,525.00
|
|
| Hospital Charge Code |
5563652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,191.28 |
| Max. Negotiated Rate |
$7,199.92 |
| Rate for Payer: Aetna Commercial |
$7,043.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,730.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,191.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,086.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,913.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,756.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,147.78
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$7,199.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,379.55
|
| Rate for Payer: Health EOS Commercial |
$6,965.14
|
| Rate for Payer: HFN Commercial |
$7,199.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,869.50
|
| Rate for Payer: Multiplan Commercial |
$6,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,199.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,834.74
|
| Rate for Payer: Quartz Commercial |
$5,086.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,695.60
|
| Rate for Payer: The Alliance Commercial |
$3,913.00
|
| Rate for Payer: WEA Trust Commercial |
$4,304.30
|
| Rate for Payer: WPS Commercial |
$5,796.51
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE PURPLE TRIEEA28MT
|
Facility
|
IP
|
$762.00
|
|
| Hospital Charge Code |
5520732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.32 |
| Max. Negotiated Rate |
$729.08 |
| Rate for Payer: Aetna Commercial |
$713.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.01
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$729.08
|
| Rate for Payer: Health EOS Commercial |
$705.31
|
| Rate for Payer: HFN Commercial |
$729.08
|
| Rate for Payer: Multiplan Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$729.08
|
| Rate for Payer: Quartz Beloit One Network |
$388.32
|
| Rate for Payer: Quartz Commercial |
$475.49
|
| Rate for Payer: WEA Trust Commercial |
$435.86
|
| Rate for Payer: WPS Commercial |
$586.97
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE PURPLE TRIEEA28MT
|
Facility
|
OP
|
$762.00
|
|
| Hospital Charge Code |
5520732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.89 |
| Max. Negotiated Rate |
$729.08 |
| Rate for Payer: Aetna Commercial |
$713.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.53
|
| Rate for Payer: Aetna Managed Medicare |
$221.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$515.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.01
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$729.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.48
|
| Rate for Payer: Health EOS Commercial |
$705.31
|
| Rate for Payer: HFN Commercial |
$729.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.36
|
| Rate for Payer: Multiplan Commercial |
$633.98
|
| Rate for Payer: NAPHCARE Commercial |
$475.49
|
| Rate for Payer: Preferred Network Access Commercial |
$729.08
|
| Rate for Payer: Quartz Beloit One Network |
$388.32
|
| Rate for Payer: Quartz Commercial |
$515.11
|
| Rate for Payer: Quartz Medicare Advantage |
$475.49
|
| Rate for Payer: The Alliance Commercial |
$396.24
|
| Rate for Payer: WEA Trust Commercial |
$435.86
|
| Rate for Payer: WPS Commercial |
$586.97
|
|
|
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 |
$2,464.43 |
| Max. Negotiated Rate |
$4,627.08 |
| Rate for Payer: Aetna Commercial |
$4,526.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.60
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,627.08
|
| Rate for Payer: Health EOS Commercial |
$4,476.20
|
| Rate for Payer: HFN Commercial |
$4,627.08
|
| Rate for Payer: Multiplan Commercial |
$4,023.55
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.43
|
| Rate for Payer: Quartz Commercial |
$3,017.66
|
| Rate for Payer: WEA Trust Commercial |
$2,766.19
|
| Rate for Payer: WPS Commercial |
$3,725.17
|
|
