|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (BLUE) GST45B/ECR45B
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.20 |
| 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: 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: Health EOS Commercial |
$1,562.41
|
| Rate for Payer: HFN Commercial |
$1,615.08
|
| Rate for Payer: Multiplan Commercial |
$1,404.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.08
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,053.31
|
| Rate for Payer: WEA Trust Commercial |
$965.54
|
| Rate for Payer: WPS Commercial |
$1,300.27
|
|
|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (VASCULAR) GST45W/ECR45W
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.20 |
| 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: 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: Health EOS Commercial |
$1,562.41
|
| Rate for Payer: HFN Commercial |
$1,615.08
|
| Rate for Payer: Multiplan Commercial |
$1,404.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.08
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,053.31
|
| Rate for Payer: WEA Trust Commercial |
$965.54
|
| Rate for Payer: WPS Commercial |
$1,300.27
|
|
|
STAPLER RELOAD ECHELON ENDOCUTTER 45MM (VASCULAR) GST45W/ECR45W
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$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
|
|
|
STAPLER RELOAD ECHELON FLEX POWERED VASCULAR 35MM VASECR35
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4595663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.25 |
| Max. Negotiated Rate |
$1,868.63 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,218.67
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
STAPLER RELOAD ECHELON FLEX POWERED VASCULAR 35MM VASECR35
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4595663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$1,868.63 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Aetna Managed Medicare |
$568.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,015.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$974.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,136.65
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.34
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,320.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.67
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
STAPLER RELOAD ECHELON POWERED 60MM (BLUE) GST60B
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4494248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,049.78 |
| Max. Negotiated Rate |
$1,971.01 |
| Rate for Payer: Aetna Commercial |
$1,928.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,842.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,135.47
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cigna Commercial |
$1,971.01
|
| Rate for Payer: Health EOS Commercial |
$1,906.74
|
| Rate for Payer: HFN Commercial |
$1,971.01
|
| Rate for Payer: Multiplan Commercial |
$1,713.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,971.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.78
|
| Rate for Payer: Quartz Commercial |
$1,285.44
|
| Rate for Payer: WEA Trust Commercial |
$1,178.32
|
| Rate for Payer: WPS Commercial |
$1,586.82
|
|
|
STAPLER RELOAD ECHELON POWERED 60MM (BLUE) GST60B
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4494248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$599.87 |
| Max. Negotiated Rate |
$1,971.01 |
| Rate for Payer: Aetna Commercial |
$1,928.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,842.46
|
| Rate for Payer: Aetna Managed Medicare |
$599.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,392.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,071.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,028.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,135.47
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cigna Commercial |
$1,971.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.92
|
| Rate for Payer: Health EOS Commercial |
$1,906.74
|
| Rate for Payer: HFN Commercial |
$1,971.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.80
|
| Rate for Payer: Multiplan Commercial |
$1,713.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,285.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,971.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.78
|
| Rate for Payer: Quartz Commercial |
$1,392.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,285.44
|
| Rate for Payer: The Alliance Commercial |
$1,071.20
|
| Rate for Payer: WEA Trust Commercial |
$1,178.32
|
| Rate for Payer: WPS Commercial |
$1,586.82
|
|
|
STAPLER RELOAD ENDOCUTTER 45MM (GREEN) GST45G
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3697500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.20 |
| 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: 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: Health EOS Commercial |
$1,562.41
|
| Rate for Payer: HFN Commercial |
$1,615.08
|
| Rate for Payer: Multiplan Commercial |
$1,404.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.08
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,053.31
|
| Rate for Payer: WEA Trust Commercial |
$965.54
|
| Rate for Payer: WPS Commercial |
$1,300.27
|
|
|
STAPLER RELOAD ENDOCUTTER 45MM (GREEN) GST45G
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3697500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$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
|
|
|
STAPLER RELOAD FLEX ETS/45MM GRAY 6R45M***SEE 2001716
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4491012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.59 |
| Max. Negotiated Rate |
$1,553.84 |
| Rate for Payer: Aetna Commercial |
$1,520.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,452.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$895.15
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$1,553.84
|
| Rate for Payer: Health EOS Commercial |
$1,503.17
|
| Rate for Payer: HFN Commercial |
$1,553.84
|
| Rate for Payer: Multiplan Commercial |
$1,351.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,553.84
|
| Rate for Payer: Quartz Beloit One Network |
$827.59
|
| Rate for Payer: Quartz Commercial |
$1,013.38
|
| Rate for Payer: WEA Trust Commercial |
$928.93
|
| Rate for Payer: WPS Commercial |
$1,250.97
|
|
|
STAPLER RELOAD FLEX ETS/45MM GRAY 6R45M***SEE 2001716
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4491012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.91 |
| Max. Negotiated Rate |
$1,553.84 |
| Rate for Payer: Aetna Commercial |
$1,520.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,452.51
|
| Rate for Payer: Aetna Managed Medicare |
$472.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,097.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$844.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$810.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$895.15
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$1,553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$945.17
|
| Rate for Payer: Health EOS Commercial |
$1,503.17
|
| Rate for Payer: HFN Commercial |
$1,553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,266.72
|
| Rate for Payer: Multiplan Commercial |
$1,351.17
|
| Rate for Payer: NAPHCARE Commercial |
$1,013.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,553.84
|
| Rate for Payer: Quartz Beloit One Network |
$827.59
|
| Rate for Payer: Quartz Commercial |
$1,097.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,013.38
|
| Rate for Payer: The Alliance Commercial |
$844.48
|
| Rate for Payer: WEA Trust Commercial |
$928.93
|
| Rate for Payer: WPS Commercial |
$1,250.97
|
|
|
STAPLER RELOAD GREEN 030456
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962863
|
|
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 GREEN 030456
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962863
|
|
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 HERNIA 4.8MM
|
Facility
|
OP
|
$1,504.00
|
|
| Hospital Charge Code |
2962990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.96 |
| Max. Negotiated Rate |
$1,439.03 |
| Rate for Payer: Aetna Commercial |
$1,407.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.18
|
| Rate for Payer: Aetna Managed Medicare |
$437.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,016.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$782.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$750.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.00
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$1,439.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$875.33
|
| Rate for Payer: Health EOS Commercial |
$1,392.10
|
| Rate for Payer: HFN Commercial |
$1,439.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.12
|
| Rate for Payer: Multiplan Commercial |
$1,251.33
|
| Rate for Payer: NAPHCARE Commercial |
$938.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.03
|
| Rate for Payer: Quartz Beloit One Network |
$766.44
|
| Rate for Payer: Quartz Commercial |
$1,016.70
|
| Rate for Payer: Quartz Medicare Advantage |
$938.50
|
| Rate for Payer: The Alliance Commercial |
$782.08
|
| Rate for Payer: WEA Trust Commercial |
$860.29
|
| Rate for Payer: WPS Commercial |
$1,158.53
|
|
|
STAPLER RELOAD HERNIA 4.8MM
|
Facility
|
IP
|
$1,504.00
|
|
| Hospital Charge Code |
2962990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$766.44 |
| Max. Negotiated Rate |
$1,439.03 |
| Rate for Payer: Aetna Commercial |
$1,407.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.00
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$1,439.03
|
| Rate for Payer: Health EOS Commercial |
$1,392.10
|
| Rate for Payer: HFN Commercial |
$1,439.03
|
| Rate for Payer: Multiplan Commercial |
$1,251.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.03
|
| Rate for Payer: Quartz Beloit One Network |
$766.44
|
| Rate for Payer: Quartz Commercial |
$938.50
|
| Rate for Payer: WEA Trust Commercial |
$860.29
|
| Rate for Payer: WPS Commercial |
$1,158.53
|
|
|
STAPLER RELOAD LINEAR 90MM TRH90/TRT10
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.02 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$586.56
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
STAPLER RELOAD LINEAR 90MM TRH90/TRT10
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Aetna Managed Medicare |
$273.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.08
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.20
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: NAPHCARE Commercial |
$586.56
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$635.44
|
| Rate for Payer: Quartz Medicare Advantage |
$586.56
|
| Rate for Payer: The Alliance Commercial |
$488.80
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
STAPLER RELOAD LINEAR (BLUE) 30MM XR30B
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.02 |
| Max. Negotiated Rate |
$726.21 |
| Rate for Payer: Aetna Commercial |
$710.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Aetna Managed Medicare |
$221.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.36
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$726.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.74
|
| Rate for Payer: Health EOS Commercial |
$702.53
|
| Rate for Payer: HFN Commercial |
$726.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.02
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: NAPHCARE Commercial |
$473.62
|
| Rate for Payer: Preferred Network Access Commercial |
$726.21
|
| Rate for Payer: Quartz Beloit One Network |
$386.79
|
| Rate for Payer: Quartz Commercial |
$513.08
|
| Rate for Payer: Quartz Medicare Advantage |
$473.62
|
| Rate for Payer: The Alliance Commercial |
$394.68
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$584.66
|
|
|
STAPLER RELOAD LINEAR (BLUE) 30MM XR30B
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.79 |
| Max. Negotiated Rate |
$726.21 |
| Rate for Payer: Aetna Commercial |
$710.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.36
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$726.21
|
| Rate for Payer: Health EOS Commercial |
$702.53
|
| Rate for Payer: HFN Commercial |
$726.21
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$726.21
|
| Rate for Payer: Quartz Beloit One Network |
$386.79
|
| Rate for Payer: Quartz Commercial |
$473.62
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$584.66
|
|
|
STAPLER RELOAD LINEAR (BLUE) 60MM XR60B
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$491.09
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
STAPLER RELOAD LINEAR (BLUE) 60MM XR60B
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3633512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.17 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Aetna Managed Medicare |
$229.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$532.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.03
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.86
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: NAPHCARE Commercial |
$491.09
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$532.01
|
| Rate for Payer: Quartz Medicare Advantage |
$491.09
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
STAPLER RELOAD LINEAR (BLUE) 90MM 4.8MM TA9048L
|
Facility
|
OP
|
$2,547.00
|
|
| Hospital Charge Code |
5599673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$741.69 |
| Max. Negotiated Rate |
$2,436.97 |
| Rate for Payer: Aetna Commercial |
$2,383.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,278.04
|
| Rate for Payer: Aetna Managed Medicare |
$741.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,721.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,324.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,271.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.91
|
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Cigna Commercial |
$2,436.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,482.35
|
| Rate for Payer: Health EOS Commercial |
$2,357.50
|
| Rate for Payer: HFN Commercial |
$2,436.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,986.66
|
| Rate for Payer: Multiplan Commercial |
$2,119.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,589.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,436.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,297.95
|
| Rate for Payer: Quartz Commercial |
$1,721.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,589.33
|
| Rate for Payer: The Alliance Commercial |
$1,324.44
|
| Rate for Payer: WEA Trust Commercial |
$1,456.88
|
| Rate for Payer: WPS Commercial |
$1,961.95
|
|
|
STAPLER RELOAD LINEAR (BLUE) 90MM 4.8MM TA9048L
|
Facility
|
IP
|
$2,547.00
|
|
| Hospital Charge Code |
5599673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,297.95 |
| Max. Negotiated Rate |
$2,436.97 |
| Rate for Payer: Aetna Commercial |
$2,383.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,278.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.91
|
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Cigna Commercial |
$2,436.97
|
| Rate for Payer: Health EOS Commercial |
$2,357.50
|
| Rate for Payer: HFN Commercial |
$2,436.97
|
| Rate for Payer: Multiplan Commercial |
$2,119.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,436.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,297.95
|
| Rate for Payer: Quartz Commercial |
$1,589.33
|
| Rate for Payer: WEA Trust Commercial |
$1,456.88
|
| Rate for Payer: WPS Commercial |
$1,961.95
|
|
|
STAPLER RELOAD LINEAR CUTTER 55MM TCR55
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.09 |
| Max. Negotiated Rate |
$856.34 |
| Rate for Payer: Aetna Commercial |
$837.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.32
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$856.34
|
| Rate for Payer: Health EOS Commercial |
$828.41
|
| Rate for Payer: HFN Commercial |
$856.34
|
| Rate for Payer: Multiplan Commercial |
$744.64
|
| Rate for Payer: Preferred Network Access Commercial |
$856.34
|
| Rate for Payer: Quartz Beloit One Network |
$456.09
|
| Rate for Payer: Quartz Commercial |
$558.48
|
| Rate for Payer: WEA Trust Commercial |
$511.94
|
| Rate for Payer: WPS Commercial |
$689.42
|
|
|
STAPLER RELOAD LINEAR CUTTER 55MM TCR55
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
3591511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.62 |
| Max. Negotiated Rate |
$856.34 |
| Rate for Payer: Aetna Commercial |
$837.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.49
|
| Rate for Payer: Aetna Managed Medicare |
$260.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$446.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.32
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$856.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$520.89
|
| Rate for Payer: Health EOS Commercial |
$828.41
|
| Rate for Payer: HFN Commercial |
$856.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.10
|
| Rate for Payer: Multiplan Commercial |
$744.64
|
| Rate for Payer: NAPHCARE Commercial |
$558.48
|
| Rate for Payer: Preferred Network Access Commercial |
$856.34
|
| Rate for Payer: Quartz Beloit One Network |
$456.09
|
| Rate for Payer: Quartz Commercial |
$605.02
|
| Rate for Payer: Quartz Medicare Advantage |
$558.48
|
| Rate for Payer: The Alliance Commercial |
$465.40
|
| Rate for Payer: WEA Trust Commercial |
$511.94
|
| Rate for Payer: WPS Commercial |
$689.42
|
|
