|
STAPLER LINEAR CUTTER 75MM TLC75
|
Facility
|
OP
|
$1,780.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$518.34 |
| Max. Negotiated Rate |
$1,703.10 |
| Rate for Payer: Aetna Commercial |
$1,666.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,592.03
|
| Rate for Payer: Aetna Managed Medicare |
$518.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,203.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$925.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$888.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$981.14
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$1,703.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,035.96
|
| Rate for Payer: Health EOS Commercial |
$1,647.57
|
| Rate for Payer: HFN Commercial |
$1,703.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,388.40
|
| Rate for Payer: Multiplan Commercial |
$1,480.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,110.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,703.10
|
| Rate for Payer: Quartz Beloit One Network |
$907.09
|
| Rate for Payer: Quartz Commercial |
$1,203.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,110.72
|
| Rate for Payer: The Alliance Commercial |
$925.60
|
| Rate for Payer: WEA Trust Commercial |
$1,018.16
|
| Rate for Payer: WPS Commercial |
$1,371.13
|
|
|
STAPLER LINEAR CUTTER 75MM TLC75
|
Facility
|
IP
|
$1,780.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$907.09 |
| Max. Negotiated Rate |
$1,703.10 |
| Rate for Payer: Aetna Commercial |
$1,666.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,592.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$981.14
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$1,703.10
|
| Rate for Payer: Health EOS Commercial |
$1,647.57
|
| Rate for Payer: HFN Commercial |
$1,703.10
|
| Rate for Payer: Multiplan Commercial |
$1,480.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,703.10
|
| Rate for Payer: Quartz Beloit One Network |
$907.09
|
| Rate for Payer: Quartz Commercial |
$1,110.72
|
| Rate for Payer: WEA Trust Commercial |
$1,018.16
|
| Rate for Payer: WPS Commercial |
$1,371.13
|
|
|
STAPLER LINEAR VASCULAR 30MM TX30V
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.22 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,402.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.81
|
| Rate for Payer: Aetna Managed Medicare |
$436.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,012.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$747.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,433.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$871.84
|
| Rate for Payer: Health EOS Commercial |
$1,386.55
|
| Rate for Payer: HFN Commercial |
$1,433.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,168.44
|
| Rate for Payer: Multiplan Commercial |
$1,246.34
|
| Rate for Payer: NAPHCARE Commercial |
$934.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.29
|
| Rate for Payer: Quartz Beloit One Network |
$763.38
|
| Rate for Payer: Quartz Commercial |
$1,012.65
|
| Rate for Payer: Quartz Medicare Advantage |
$934.75
|
| Rate for Payer: The Alliance Commercial |
$778.96
|
| Rate for Payer: WEA Trust Commercial |
$856.86
|
| Rate for Payer: WPS Commercial |
$1,153.91
|
|
|
STAPLER LINEAR VASCULAR 30MM TX30V
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$763.38 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,402.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,433.29
|
| Rate for Payer: Health EOS Commercial |
$1,386.55
|
| Rate for Payer: HFN Commercial |
$1,433.29
|
| Rate for Payer: Multiplan Commercial |
$1,246.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.29
|
| Rate for Payer: Quartz Beloit One Network |
$763.38
|
| Rate for Payer: Quartz Commercial |
$934.75
|
| Rate for Payer: WEA Trust Commercial |
$856.86
|
| Rate for Payer: WPS Commercial |
$1,153.91
|
|
|
STAPLER RELOAD 30-3.5 SNGL USE
|
Facility
|
IP
|
$1,119.00
|
|
| Hospital Charge Code |
2962997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.24 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$698.26
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
STAPLER RELOAD 30-3.5 SNGL USE
|
Facility
|
OP
|
$1,119.00
|
|
| Hospital Charge Code |
2962997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$325.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$756.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.26
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.82
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$698.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$756.44
|
| Rate for Payer: Quartz Medicare Advantage |
$698.26
|
| Rate for Payer: The Alliance Commercial |
$581.88
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
STAPLER RELOAD 30-V3 SNGL USE
|
Facility
|
IP
|
$1,698.00
|
|
| Hospital Charge Code |
2969232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.30 |
| Max. Negotiated Rate |
$1,624.65 |
| Rate for Payer: Aetna Commercial |
$1,589.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,518.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$935.94
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$1,624.65
|
| Rate for Payer: Health EOS Commercial |
$1,571.67
|
| Rate for Payer: HFN Commercial |
$1,624.65
|
| Rate for Payer: Multiplan Commercial |
$1,412.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,624.65
|
| Rate for Payer: Quartz Beloit One Network |
$865.30
|
| Rate for Payer: Quartz Commercial |
$1,059.55
|
| Rate for Payer: WEA Trust Commercial |
$971.26
|
| Rate for Payer: WPS Commercial |
$1,307.97
|
|
|
STAPLER RELOAD 30-V3 SNGL USE
|
Facility
|
OP
|
$1,698.00
|
|
| Hospital Charge Code |
2969232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.46 |
| Max. Negotiated Rate |
$1,624.65 |
| Rate for Payer: Aetna Commercial |
$1,589.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,518.69
|
| Rate for Payer: Aetna Managed Medicare |
$494.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,147.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$882.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$847.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$935.94
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$1,624.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.24
|
| Rate for Payer: Health EOS Commercial |
$1,571.67
|
| Rate for Payer: HFN Commercial |
$1,624.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,324.44
|
| Rate for Payer: Multiplan Commercial |
$1,412.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,059.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,624.65
|
| Rate for Payer: Quartz Beloit One Network |
$865.30
|
| Rate for Payer: Quartz Commercial |
$1,147.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,059.55
|
| Rate for Payer: The Alliance Commercial |
$882.96
|
| Rate for Payer: WEA Trust Commercial |
$971.26
|
| Rate for Payer: WPS Commercial |
$1,307.97
|
|
|
STAPLER RELOAD 45MM BLUE 6R45B
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5306760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.79 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$994.03
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
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 |
$463.88 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Aetna Managed Medicare |
$463.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,076.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$828.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$795.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$927.13
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.54
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: NAPHCARE Commercial |
$994.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$1,076.87
|
| Rate for Payer: Quartz Medicare Advantage |
$994.03
|
| Rate for Payer: The Alliance Commercial |
$828.36
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
STAPLER RELOAD 45MM VASCULAR WHITE TR-45W
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2962946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
STAPLER RELOAD 45MM VASCULAR WHITE TR-45W
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2962946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
STAPLER RELOAD 60-3.5 SNGL USE
|
Facility
|
OP
|
$1,186.00
|
|
| Hospital Charge Code |
2962987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.36 |
| Max. Negotiated Rate |
$1,134.76 |
| Rate for Payer: Aetna Commercial |
$1,110.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.76
|
| Rate for Payer: Aetna Managed Medicare |
$345.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.72
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,134.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.25
|
| Rate for Payer: Health EOS Commercial |
$1,097.76
|
| Rate for Payer: HFN Commercial |
$1,134.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.08
|
| Rate for Payer: Multiplan Commercial |
$986.75
|
| Rate for Payer: NAPHCARE Commercial |
$740.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.76
|
| Rate for Payer: Quartz Beloit One Network |
$604.39
|
| Rate for Payer: Quartz Commercial |
$801.74
|
| Rate for Payer: Quartz Medicare Advantage |
$740.06
|
| Rate for Payer: The Alliance Commercial |
$616.72
|
| Rate for Payer: WEA Trust Commercial |
$678.39
|
| Rate for Payer: WPS Commercial |
$913.58
|
|
|
STAPLER RELOAD 60-3.5 SNGL USE
|
Facility
|
IP
|
$1,186.00
|
|
| Hospital Charge Code |
2962987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.39 |
| Max. Negotiated Rate |
$1,134.76 |
| Rate for Payer: Aetna Commercial |
$1,110.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.72
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,134.76
|
| Rate for Payer: Health EOS Commercial |
$1,097.76
|
| Rate for Payer: HFN Commercial |
$1,134.76
|
| Rate for Payer: Multiplan Commercial |
$986.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.76
|
| Rate for Payer: Quartz Beloit One Network |
$604.39
|
| Rate for Payer: Quartz Commercial |
$740.06
|
| Rate for Payer: WEA Trust Commercial |
$678.39
|
| Rate for Payer: WPS Commercial |
$913.58
|
|
|
STAPLER RELOAD 60-3.8
|
Facility
|
IP
|
$2,643.00
|
|
| Hospital Charge Code |
2962963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.87 |
| Max. Negotiated Rate |
$2,528.82 |
| Rate for Payer: Aetna Commercial |
$2,473.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,363.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,456.82
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna Commercial |
$2,528.82
|
| Rate for Payer: Health EOS Commercial |
$2,446.36
|
| Rate for Payer: HFN Commercial |
$2,528.82
|
| Rate for Payer: Multiplan Commercial |
$2,198.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,528.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.87
|
| Rate for Payer: Quartz Commercial |
$1,649.23
|
| Rate for Payer: WEA Trust Commercial |
$1,511.80
|
| Rate for Payer: WPS Commercial |
$2,035.90
|
|
|
STAPLER RELOAD 60-3.8
|
Facility
|
OP
|
$2,643.00
|
|
| Hospital Charge Code |
2962963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.64 |
| Max. Negotiated Rate |
$2,528.82 |
| Rate for Payer: Aetna Commercial |
$2,473.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,363.90
|
| Rate for Payer: Aetna Managed Medicare |
$769.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,786.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,374.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,319.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,456.82
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna Commercial |
$2,528.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,538.23
|
| Rate for Payer: Health EOS Commercial |
$2,446.36
|
| Rate for Payer: HFN Commercial |
$2,528.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,061.54
|
| Rate for Payer: Multiplan Commercial |
$2,198.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,649.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,528.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.87
|
| Rate for Payer: Quartz Commercial |
$1,786.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,649.23
|
| Rate for Payer: The Alliance Commercial |
$1,374.36
|
| Rate for Payer: WEA Trust Commercial |
$1,511.80
|
| Rate for Payer: WPS Commercial |
$2,035.90
|
|
|
STAPLER RELOAD 60-4.8 SNGL USE
|
Facility
|
IP
|
$997.00
|
|
| Hospital Charge Code |
2962985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.07 |
| Max. Negotiated Rate |
$953.93 |
| Rate for Payer: Aetna Commercial |
$933.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$891.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$549.55
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cigna Commercial |
$953.93
|
| Rate for Payer: Health EOS Commercial |
$922.82
|
| Rate for Payer: HFN Commercial |
$953.93
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Preferred Network Access Commercial |
$953.93
|
| Rate for Payer: Quartz Beloit One Network |
$508.07
|
| Rate for Payer: Quartz Commercial |
$622.13
|
| Rate for Payer: WEA Trust Commercial |
$570.28
|
| Rate for Payer: WPS Commercial |
$767.99
|
|
|
STAPLER RELOAD 60-4.8 SNGL USE
|
Facility
|
OP
|
$997.00
|
|
| Hospital Charge Code |
2962985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.33 |
| Max. Negotiated Rate |
$953.93 |
| Rate for Payer: Aetna Commercial |
$933.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$891.72
|
| Rate for Payer: Aetna Managed Medicare |
$290.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$673.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$518.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$497.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$549.55
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cigna Commercial |
$953.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.25
|
| Rate for Payer: Health EOS Commercial |
$922.82
|
| Rate for Payer: HFN Commercial |
$953.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$777.66
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: NAPHCARE Commercial |
$622.13
|
| Rate for Payer: Preferred Network Access Commercial |
$953.93
|
| Rate for Payer: Quartz Beloit One Network |
$508.07
|
| Rate for Payer: Quartz Commercial |
$673.97
|
| Rate for Payer: Quartz Medicare Advantage |
$622.13
|
| Rate for Payer: The Alliance Commercial |
$518.44
|
| Rate for Payer: WEA Trust Commercial |
$570.28
|
| Rate for Payer: WPS Commercial |
$767.99
|
|
|
STAPLER RELOAD BLUE 030455
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$839.82 |
| Max. Negotiated Rate |
$1,576.81 |
| Rate for Payer: Aetna Commercial |
$1,542.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.38
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,576.81
|
| Rate for Payer: Health EOS Commercial |
$1,525.39
|
| Rate for Payer: HFN Commercial |
$1,576.81
|
| Rate for Payer: Multiplan Commercial |
$1,371.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,576.81
|
| Rate for Payer: Quartz Beloit One Network |
$839.82
|
| Rate for Payer: Quartz Commercial |
$1,028.35
|
| Rate for Payer: WEA Trust Commercial |
$942.66
|
| Rate for Payer: WPS Commercial |
$1,269.45
|
|
|
STAPLER RELOAD BLUE 030455
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.90 |
| Max. Negotiated Rate |
$1,576.81 |
| Rate for Payer: Aetna Commercial |
$1,542.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.97
|
| Rate for Payer: Aetna Managed Medicare |
$479.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,114.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.38
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,576.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$959.14
|
| Rate for Payer: Health EOS Commercial |
$1,525.39
|
| Rate for Payer: HFN Commercial |
$1,576.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,285.44
|
| Rate for Payer: Multiplan Commercial |
$1,371.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,028.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,576.81
|
| Rate for Payer: Quartz Beloit One Network |
$839.82
|
| Rate for Payer: Quartz Commercial |
$1,114.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,028.35
|
| Rate for Payer: The Alliance Commercial |
$856.96
|
| Rate for Payer: WEA Trust Commercial |
$942.66
|
| Rate for Payer: WPS Commercial |
$1,269.45
|
|
|
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 |
$1,037.55 |
| Max. Negotiated Rate |
$3,409.08 |
| Rate for Payer: Aetna Commercial |
$3,334.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,186.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,408.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,852.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,778.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,963.93
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,409.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,073.67
|
| Rate for Payer: Health EOS Commercial |
$3,297.91
|
| Rate for Payer: HFN Commercial |
$3,409.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.14
|
| Rate for Payer: Multiplan Commercial |
$2,964.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.70
|
| Rate for Payer: Quartz Commercial |
$2,408.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.31
|
| Rate for Payer: The Alliance Commercial |
$1,852.76
|
| Rate for Payer: WEA Trust Commercial |
$2,038.04
|
| Rate for Payer: WPS Commercial |
$2,744.58
|
|
|
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 |
$1,815.70 |
| Max. Negotiated Rate |
$3,409.08 |
| Rate for Payer: Aetna Commercial |
$3,334.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,186.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,963.93
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,409.08
|
| Rate for Payer: Health EOS Commercial |
$3,297.91
|
| Rate for Payer: HFN Commercial |
$3,409.08
|
| Rate for Payer: Multiplan Commercial |
$2,964.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.70
|
| Rate for Payer: Quartz Commercial |
$2,223.31
|
| Rate for Payer: WEA Trust Commercial |
$2,038.04
|
| Rate for Payer: WPS Commercial |
$2,744.58
|
|
|
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 |
$1,037.55 |
| Max. Negotiated Rate |
$3,409.08 |
| Rate for Payer: Aetna Commercial |
$3,334.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,186.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,408.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,852.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,778.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,963.93
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,409.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,073.67
|
| Rate for Payer: Health EOS Commercial |
$3,297.91
|
| Rate for Payer: HFN Commercial |
$3,409.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.14
|
| Rate for Payer: Multiplan Commercial |
$2,964.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.70
|
| Rate for Payer: Quartz Commercial |
$2,408.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.31
|
| Rate for Payer: The Alliance Commercial |
$1,852.76
|
| Rate for Payer: WEA Trust Commercial |
$2,038.04
|
| Rate for Payer: WPS Commercial |
$2,744.58
|
|
|
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 |
$1,815.70 |
| Max. Negotiated Rate |
$3,409.08 |
| Rate for Payer: Aetna Commercial |
$3,334.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,186.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,963.93
|
| Rate for Payer: Cash Price |
$1,068.90
|
| Rate for Payer: Cigna Commercial |
$3,409.08
|
| Rate for Payer: Health EOS Commercial |
$3,297.91
|
| Rate for Payer: HFN Commercial |
$3,409.08
|
| Rate for Payer: Multiplan Commercial |
$2,964.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.70
|
| Rate for Payer: Quartz Commercial |
$2,223.31
|
| Rate for Payer: WEA Trust Commercial |
$2,038.04
|
| Rate for Payer: WPS Commercial |
$2,744.58
|
|
|
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 |
$491.55 |
| Max. Negotiated Rate |
$1,615.08 |
| Rate for Payer: Aetna Commercial |
$1,579.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,509.75
|
| Rate for Payer: Aetna Managed Medicare |
$491.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,141.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$877.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$842.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.43
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,615.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.42
|
| Rate for Payer: Health EOS Commercial |
$1,562.41
|
| Rate for Payer: HFN Commercial |
$1,615.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,316.64
|
| Rate for Payer: Multiplan Commercial |
$1,404.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.08
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,141.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,053.31
|
| Rate for Payer: The Alliance Commercial |
$877.76
|
| Rate for Payer: WEA Trust Commercial |
$965.54
|
| Rate for Payer: WPS Commercial |
$1,300.27
|
|
