|
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 |
$1,408.24 |
| 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 ENDO GIA 12MM SNGL USE
|
Facility
|
OP
|
$3,517.00
|
|
| Hospital Charge Code |
2962965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.15 |
| Max. Negotiated Rate |
$3,365.07 |
| Rate for Payer: Aetna Commercial |
$3,291.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,024.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,377.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,828.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,755.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.57
|
| Rate for Payer: Cash Price |
$1,055.10
|
| Rate for Payer: Cigna Commercial |
$3,365.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,046.89
|
| Rate for Payer: Health EOS Commercial |
$3,255.34
|
| Rate for Payer: HFN Commercial |
$3,365.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,743.26
|
| Rate for Payer: Multiplan Commercial |
$2,926.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,194.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,365.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.26
|
| Rate for Payer: Quartz Commercial |
$2,377.49
|
| Rate for Payer: Quartz Medicare Advantage |
$2,194.61
|
| Rate for Payer: The Alliance Commercial |
$1,828.84
|
| Rate for Payer: WEA Trust Commercial |
$2,011.72
|
| Rate for Payer: WPS Commercial |
$2,709.15
|
|
|
STAPLER ENDO GIA 12MM SNGL USE
|
Facility
|
IP
|
$3,517.00
|
|
| Hospital Charge Code |
2962965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.26 |
| Max. Negotiated Rate |
$3,365.07 |
| Rate for Payer: Aetna Commercial |
$3,291.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,145.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,938.57
|
| Rate for Payer: Cash Price |
$1,055.10
|
| Rate for Payer: Cigna Commercial |
$3,365.07
|
| Rate for Payer: Health EOS Commercial |
$3,255.34
|
| Rate for Payer: HFN Commercial |
$3,365.07
|
| Rate for Payer: Multiplan Commercial |
$2,926.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,365.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.26
|
| Rate for Payer: Quartz Commercial |
$2,194.61
|
| Rate for Payer: WEA Trust Commercial |
$2,011.72
|
| Rate for Payer: WPS Commercial |
$2,709.15
|
|
|
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 |
$1,952.79 |
| Max. Negotiated Rate |
$3,666.46 |
| Rate for Payer: Aetna Commercial |
$3,586.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,427.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,112.20
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,666.46
|
| Rate for Payer: Health EOS Commercial |
$3,546.90
|
| Rate for Payer: HFN Commercial |
$3,666.46
|
| Rate for Payer: Multiplan Commercial |
$3,188.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,666.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,952.79
|
| Rate for Payer: Quartz Commercial |
$2,391.17
|
| Rate for Payer: WEA Trust Commercial |
$2,191.90
|
| Rate for Payer: WPS Commercial |
$2,951.79
|
|
|
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 |
$1,115.88 |
| Max. Negotiated Rate |
$3,666.46 |
| Rate for Payer: Aetna Commercial |
$3,586.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,427.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,115.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,590.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,992.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,912.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,112.20
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,666.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,230.22
|
| Rate for Payer: Health EOS Commercial |
$3,546.90
|
| Rate for Payer: HFN Commercial |
$3,666.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,988.96
|
| Rate for Payer: Multiplan Commercial |
$3,188.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,391.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,666.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,952.79
|
| Rate for Payer: Quartz Commercial |
$2,590.43
|
| Rate for Payer: Quartz Medicare Advantage |
$2,391.17
|
| Rate for Payer: The Alliance Commercial |
$1,992.64
|
| Rate for Payer: WEA Trust Commercial |
$2,191.90
|
| Rate for Payer: WPS Commercial |
$2,951.79
|
|
|
STAPLER HANDLE ENDOGIA ULTRA SHORT EGIAUSHORT
|
Facility
|
IP
|
$3,412.00
|
|
| Hospital Charge Code |
5547296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,738.76 |
| Max. Negotiated Rate |
$3,264.60 |
| Rate for Payer: Aetna Commercial |
$3,193.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,051.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,880.69
|
| Rate for Payer: Cash Price |
$1,023.60
|
| Rate for Payer: Cigna Commercial |
$3,264.60
|
| Rate for Payer: Health EOS Commercial |
$3,158.15
|
| Rate for Payer: HFN Commercial |
$3,264.60
|
| Rate for Payer: Multiplan Commercial |
$2,838.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,264.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,738.76
|
| Rate for Payer: Quartz Commercial |
$2,129.09
|
| Rate for Payer: WEA Trust Commercial |
$1,951.66
|
| Rate for Payer: WPS Commercial |
$2,628.26
|
|
|
STAPLER HANDLE ENDOGIA ULTRA SHORT EGIAUSHORT
|
Facility
|
OP
|
$3,412.00
|
|
| Hospital Charge Code |
5547296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.57 |
| Max. Negotiated Rate |
$3,264.60 |
| Rate for Payer: Aetna Commercial |
$3,193.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,051.69
|
| Rate for Payer: Aetna Managed Medicare |
$993.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,306.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,774.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,703.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,880.69
|
| Rate for Payer: Cash Price |
$1,023.60
|
| Rate for Payer: Cigna Commercial |
$3,264.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,985.78
|
| Rate for Payer: Health EOS Commercial |
$3,158.15
|
| Rate for Payer: HFN Commercial |
$3,264.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,661.36
|
| Rate for Payer: Multiplan Commercial |
$2,838.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,129.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,264.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,738.76
|
| Rate for Payer: Quartz Commercial |
$2,306.51
|
| Rate for Payer: Quartz Medicare Advantage |
$2,129.09
|
| Rate for Payer: The Alliance Commercial |
$1,774.24
|
| Rate for Payer: WEA Trust Commercial |
$1,951.66
|
| Rate for Payer: WPS Commercial |
$2,628.26
|
|
|
STAPLER HANDLE ENDOGIA ULTRA STD EGIAUSTND
|
Facility
|
IP
|
$3,490.00
|
|
| Hospital Charge Code |
4462803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,778.50 |
| Max. Negotiated Rate |
$3,339.23 |
| Rate for Payer: Aetna Commercial |
$3,266.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,121.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,923.69
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$3,339.23
|
| Rate for Payer: Health EOS Commercial |
$3,230.34
|
| Rate for Payer: HFN Commercial |
$3,339.23
|
| Rate for Payer: Multiplan Commercial |
$2,903.68
|
| Rate for Payer: Preferred Network Access Commercial |
$3,339.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,778.50
|
| Rate for Payer: Quartz Commercial |
$2,177.76
|
| Rate for Payer: WEA Trust Commercial |
$1,996.28
|
| Rate for Payer: WPS Commercial |
$2,688.35
|
|
|
STAPLER HANDLE ENDOGIA ULTRA STD EGIAUSTND
|
Facility
|
OP
|
$3,490.00
|
|
| Hospital Charge Code |
4462803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,016.29 |
| Max. Negotiated Rate |
$3,339.23 |
| Rate for Payer: Aetna Commercial |
$3,266.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,121.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,016.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,359.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,814.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,742.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,923.69
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$3,339.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,031.18
|
| Rate for Payer: Health EOS Commercial |
$3,230.34
|
| Rate for Payer: HFN Commercial |
$3,339.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,722.20
|
| Rate for Payer: Multiplan Commercial |
$2,903.68
|
| Rate for Payer: NAPHCARE Commercial |
$2,177.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,339.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,778.50
|
| Rate for Payer: Quartz Commercial |
$2,359.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,177.76
|
| Rate for Payer: The Alliance Commercial |
$1,814.80
|
| Rate for Payer: WEA Trust Commercial |
$1,996.28
|
| Rate for Payer: WPS Commercial |
$2,688.35
|
|
|
STAPLER HEMORRHOID CIRCULAR PPH03
|
Facility
|
IP
|
$5,314.00
|
|
| Hospital Charge Code |
2969373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.01 |
| Max. Negotiated Rate |
$5,084.44 |
| Rate for Payer: Aetna Commercial |
$4,973.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.08
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$5,084.44
|
| Rate for Payer: Health EOS Commercial |
$4,918.64
|
| Rate for Payer: HFN Commercial |
$5,084.44
|
| Rate for Payer: Multiplan Commercial |
$4,421.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,084.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.01
|
| Rate for Payer: Quartz Commercial |
$3,315.94
|
| Rate for Payer: WEA Trust Commercial |
$3,039.61
|
| Rate for Payer: WPS Commercial |
$4,093.37
|
|
|
STAPLER HEMORRHOID CIRCULAR PPH03
|
Facility
|
OP
|
$5,314.00
|
|
| Hospital Charge Code |
2969373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.44 |
| Max. Negotiated Rate |
$5,084.44 |
| Rate for Payer: Aetna Commercial |
$4,973.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,752.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,652.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.08
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$5,084.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,092.75
|
| Rate for Payer: Health EOS Commercial |
$4,918.64
|
| Rate for Payer: HFN Commercial |
$5,084.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,144.92
|
| Rate for Payer: Multiplan Commercial |
$4,421.25
|
| Rate for Payer: NAPHCARE Commercial |
$3,315.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,084.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.01
|
| Rate for Payer: Quartz Commercial |
$3,592.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3,315.94
|
| Rate for Payer: The Alliance Commercial |
$2,763.28
|
| Rate for Payer: WEA Trust Commercial |
$3,039.61
|
| Rate for Payer: WPS Commercial |
$4,093.37
|
|
|
STAPLER LDS POWERED 15W
|
Facility
|
IP
|
$1,977.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,007.48 |
| Max. Negotiated Rate |
$1,891.59 |
| Rate for Payer: Aetna Commercial |
$1,850.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.72
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,891.59
|
| Rate for Payer: Health EOS Commercial |
$1,829.91
|
| Rate for Payer: HFN Commercial |
$1,891.59
|
| Rate for Payer: Multiplan Commercial |
$1,644.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.48
|
| Rate for Payer: Quartz Commercial |
$1,233.65
|
| Rate for Payer: WEA Trust Commercial |
$1,130.84
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
STAPLER LDS POWERED 15W
|
Facility
|
OP
|
$1,977.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.70 |
| Max. Negotiated Rate |
$1,891.59 |
| Rate for Payer: Aetna Commercial |
$1,850.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.23
|
| Rate for Payer: Aetna Managed Medicare |
$575.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,336.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,028.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.72
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna Commercial |
$1,891.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,150.61
|
| Rate for Payer: Health EOS Commercial |
$1,829.91
|
| Rate for Payer: HFN Commercial |
$1,891.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,542.06
|
| Rate for Payer: Multiplan Commercial |
$1,644.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.48
|
| Rate for Payer: Quartz Commercial |
$1,336.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.65
|
| Rate for Payer: The Alliance Commercial |
$1,028.04
|
| Rate for Payer: WEA Trust Commercial |
$1,130.84
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
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 |
$501.74 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$501.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.79
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.94
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,164.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.15
|
| Rate for Payer: The Alliance Commercial |
$895.96
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
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 |
$878.04 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,075.15
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
STAPLER LIN CUT 80-3.8 GIA8035S
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
2962924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
STAPLER LIN CUT 80-3.8 GIA8035S
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
2962924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.71 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
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 |
$786.31 |
| Max. Negotiated Rate |
$1,476.34 |
| Rate for Payer: Aetna Commercial |
$1,444.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$850.50
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,476.34
|
| Rate for Payer: Health EOS Commercial |
$1,428.20
|
| Rate for Payer: HFN Commercial |
$1,476.34
|
| Rate for Payer: Multiplan Commercial |
$1,283.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,476.34
|
| Rate for Payer: Quartz Beloit One Network |
$786.31
|
| Rate for Payer: Quartz Commercial |
$962.83
|
| Rate for Payer: WEA Trust Commercial |
$882.60
|
| Rate for Payer: WPS Commercial |
$1,188.57
|
|
|
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 |
$449.32 |
| Max. Negotiated Rate |
$1,476.34 |
| Rate for Payer: Aetna Commercial |
$1,444.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.06
|
| Rate for Payer: Aetna Managed Medicare |
$449.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,043.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$802.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$770.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$850.50
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,476.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$898.03
|
| Rate for Payer: Health EOS Commercial |
$1,428.20
|
| Rate for Payer: HFN Commercial |
$1,476.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,203.54
|
| Rate for Payer: Multiplan Commercial |
$1,283.78
|
| Rate for Payer: NAPHCARE Commercial |
$962.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,476.34
|
| Rate for Payer: Quartz Beloit One Network |
$786.31
|
| Rate for Payer: Quartz Commercial |
$1,043.07
|
| Rate for Payer: Quartz Medicare Advantage |
$962.83
|
| Rate for Payer: The Alliance Commercial |
$802.36
|
| Rate for Payer: WEA Trust Commercial |
$882.60
|
| Rate for Payer: WPS Commercial |
$1,188.57
|
|
|
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 |
$402.44 |
| Max. Negotiated Rate |
$1,322.30 |
| Rate for Payer: Aetna Commercial |
$1,293.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.06
|
| Rate for Payer: Aetna Managed Medicare |
$402.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$934.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$718.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$689.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.76
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$1,322.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.32
|
| Rate for Payer: Health EOS Commercial |
$1,279.18
|
| Rate for Payer: HFN Commercial |
$1,322.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,077.96
|
| Rate for Payer: Multiplan Commercial |
$1,149.82
|
| Rate for Payer: NAPHCARE Commercial |
$862.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,322.30
|
| Rate for Payer: Quartz Beloit One Network |
$704.27
|
| Rate for Payer: Quartz Commercial |
$934.23
|
| Rate for Payer: Quartz Medicare Advantage |
$862.37
|
| Rate for Payer: The Alliance Commercial |
$718.64
|
| Rate for Payer: WEA Trust Commercial |
$790.50
|
| Rate for Payer: WPS Commercial |
$1,064.55
|
|
|
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 |
$704.27 |
| Max. Negotiated Rate |
$1,322.30 |
| Rate for Payer: Aetna Commercial |
$1,293.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.76
|
| Rate for Payer: Cash Price |
$414.60
|
| Rate for Payer: Cigna Commercial |
$1,322.30
|
| Rate for Payer: Health EOS Commercial |
$1,279.18
|
| Rate for Payer: HFN Commercial |
$1,322.30
|
| Rate for Payer: Multiplan Commercial |
$1,149.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,322.30
|
| Rate for Payer: Quartz Beloit One Network |
$704.27
|
| Rate for Payer: Quartz Commercial |
$862.37
|
| Rate for Payer: WEA Trust Commercial |
$790.50
|
| Rate for Payer: WPS Commercial |
$1,064.55
|
|
|
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 |
$713.95 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$874.22
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
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 |
$407.97 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Aetna Managed Medicare |
$407.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$947.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$699.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$815.38
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.78
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: NAPHCARE Commercial |
$874.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$947.08
|
| Rate for Payer: Quartz Medicare Advantage |
$874.22
|
| Rate for Payer: The Alliance Commercial |
$728.52
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
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 |
$729.75 |
| Max. Negotiated Rate |
$1,370.14 |
| Rate for Payer: Aetna Commercial |
$1,340.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,280.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.32
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$1,370.14
|
| Rate for Payer: Health EOS Commercial |
$1,325.46
|
| Rate for Payer: HFN Commercial |
$1,370.14
|
| Rate for Payer: Multiplan Commercial |
$1,191.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.14
|
| Rate for Payer: Quartz Beloit One Network |
$729.75
|
| Rate for Payer: Quartz Commercial |
$893.57
|
| Rate for Payer: WEA Trust Commercial |
$819.10
|
| Rate for Payer: WPS Commercial |
$1,103.07
|
|
|
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 |
$417.00 |
| Max. Negotiated Rate |
$1,370.14 |
| Rate for Payer: Aetna Commercial |
$1,340.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,280.78
|
| Rate for Payer: Aetna Managed Medicare |
$417.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$968.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$744.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$714.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.32
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$1,370.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$833.42
|
| Rate for Payer: Health EOS Commercial |
$1,325.46
|
| Rate for Payer: HFN Commercial |
$1,370.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.96
|
| Rate for Payer: Multiplan Commercial |
$1,191.42
|
| Rate for Payer: NAPHCARE Commercial |
$893.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.14
|
| Rate for Payer: Quartz Beloit One Network |
$729.75
|
| Rate for Payer: Quartz Commercial |
$968.03
|
| Rate for Payer: Quartz Medicare Advantage |
$893.57
|
| Rate for Payer: The Alliance Commercial |
$744.64
|
| Rate for Payer: WEA Trust Commercial |
$819.10
|
| Rate for Payer: WPS Commercial |
$1,103.07
|
|
