|
STAPLER ECHELON CIRCULAR POWERED EEA 25MM CDH25P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5729638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.36 |
| Max. Negotiated Rate |
$19,048.00 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,095.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,285.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,664.82
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,571.50
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$3,095.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.20
|
| Rate for Payer: The Alliance Commercial |
$19,048.00
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 25MM CDH25P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5729638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,333.38 |
| Max. Negotiated Rate |
$4,381.04 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$2,857.20
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 29MM CDH29P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5685755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.36 |
| Max. Negotiated Rate |
$19,048.00 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,095.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,285.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,664.82
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,571.50
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$3,095.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.20
|
| Rate for Payer: The Alliance Commercial |
$19,048.00
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 29MM CDH29P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5685755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,333.38 |
| Max. Negotiated Rate |
$4,381.04 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$2,857.20
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 31MM CDH31P
|
Facility
|
OP
|
$4,762.00
|
|
| Hospital Charge Code |
5729639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.36 |
| Max. Negotiated Rate |
$19,048.00 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,095.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,285.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,664.82
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,571.50
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$3,095.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.20
|
| Rate for Payer: The Alliance Commercial |
$19,048.00
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON CIRCULAR POWERED EEA 31MM CDH31P
|
Facility
|
IP
|
$4,762.00
|
|
| Hospital Charge Code |
5729639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,333.38 |
| Max. Negotiated Rate |
$4,381.04 |
| Rate for Payer: Aetna Commercial |
$4,285.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.86
|
| Rate for Payer: Cash Price |
$1,428.60
|
| Rate for Payer: Cigna Commercial |
$4,381.04
|
| Rate for Payer: Health EOS Commercial |
$4,238.18
|
| Rate for Payer: HFN Commercial |
$4,381.04
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.38
|
| Rate for Payer: Quartz Commercial |
$2,857.20
|
| Rate for Payer: WEA Trust Commercial |
$2,619.10
|
| Rate for Payer: WPS Commercial |
$3,527.21
|
|
|
STAPLER ECHELON ENDOCUTTER POWERED 45MM PSEE45A / ECH45S
|
Facility
|
OP
|
$3,526.00
|
|
| Hospital Charge Code |
3633513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$987.28 |
| Max. Negotiated Rate |
$14,104.00 |
| Rate for Payer: Aetna Commercial |
$3,173.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,032.36
|
| Rate for Payer: Aetna Managed Medicare |
$987.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,291.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,763.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,868.78
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Cigna Commercial |
$3,243.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,973.15
|
| Rate for Payer: Health EOS Commercial |
$3,138.14
|
| Rate for Payer: HFN Commercial |
$3,243.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,644.50
|
| Rate for Payer: Multiplan Commercial |
$2,820.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,115.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,243.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.74
|
| Rate for Payer: Quartz Commercial |
$2,291.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,115.60
|
| Rate for Payer: The Alliance Commercial |
$14,104.00
|
| Rate for Payer: WEA Trust Commercial |
$1,939.30
|
| Rate for Payer: WPS Commercial |
$2,611.71
|
|
|
STAPLER ECHELON ENDOCUTTER POWERED 45MM PSEE45A / ECH45S
|
Facility
|
IP
|
$3,526.00
|
|
| Hospital Charge Code |
3633513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,727.74 |
| Max. Negotiated Rate |
$3,243.92 |
| Rate for Payer: Aetna Commercial |
$3,173.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,032.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,868.78
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Cigna Commercial |
$3,243.92
|
| Rate for Payer: Health EOS Commercial |
$3,138.14
|
| Rate for Payer: HFN Commercial |
$3,243.92
|
| Rate for Payer: Multiplan Commercial |
$2,820.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,115.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,243.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.74
|
| Rate for Payer: Quartz Commercial |
$2,115.60
|
| Rate for Payer: WEA Trust Commercial |
$1,939.30
|
| Rate for Payer: WPS Commercial |
$2,611.71
|
|
|
STAPLER ECHELON POWERED 60MM PSEE60A
|
Facility
|
OP
|
$3,912.00
|
|
| Hospital Charge Code |
4494247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,095.36 |
| Max. Negotiated Rate |
$15,648.00 |
| Rate for Payer: Aetna Commercial |
$3,520.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,364.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,095.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,542.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,956.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,877.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,073.36
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cigna Commercial |
$3,599.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$3,481.68
|
| Rate for Payer: HFN Commercial |
$3,599.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,934.00
|
| Rate for Payer: Multiplan Commercial |
$3,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,599.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,916.88
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,347.20
|
| Rate for Payer: The Alliance Commercial |
$15,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,151.60
|
| Rate for Payer: WPS Commercial |
$2,897.62
|
|
|
STAPLER ECHELON POWERED 60MM PSEE60A
|
Facility
|
IP
|
$3,912.00
|
|
| Hospital Charge Code |
4494247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,916.88 |
| Max. Negotiated Rate |
$3,599.04 |
| Rate for Payer: Aetna Commercial |
$3,520.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,364.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,073.36
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cigna Commercial |
$3,599.04
|
| Rate for Payer: Health EOS Commercial |
$3,481.68
|
| Rate for Payer: HFN Commercial |
$3,599.04
|
| Rate for Payer: Multiplan Commercial |
$3,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,599.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,916.88
|
| Rate for Payer: Quartz Commercial |
$2,347.20
|
| Rate for Payer: WEA Trust Commercial |
$2,151.60
|
| Rate for Payer: WPS Commercial |
$2,897.62
|
|
|
STAPLER ECHELON POWERED VASCULAR 35MM PVE35A
|
Facility
|
IP
|
$3,396.00
|
|
| Hospital Charge Code |
4595662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,664.04 |
| Max. Negotiated Rate |
$3,124.32 |
| Rate for Payer: Aetna Commercial |
$3,056.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,124.32
|
| Rate for Payer: Health EOS Commercial |
$3,022.44
|
| Rate for Payer: HFN Commercial |
$3,124.32
|
| Rate for Payer: Multiplan Commercial |
$2,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,124.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.04
|
| Rate for Payer: Quartz Commercial |
$2,037.60
|
| Rate for Payer: WEA Trust Commercial |
$1,867.80
|
| Rate for Payer: WPS Commercial |
$2,515.42
|
|
|
STAPLER ECHELON POWERED VASCULAR 35MM PVE35A
|
Facility
|
OP
|
$3,396.00
|
|
| Hospital Charge Code |
4595662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$950.88 |
| Max. Negotiated Rate |
$13,584.00 |
| Rate for Payer: Aetna Commercial |
$3,056.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.56
|
| Rate for Payer: Aetna Managed Medicare |
$950.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,207.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,698.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,630.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,124.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.40
|
| Rate for Payer: Health EOS Commercial |
$3,022.44
|
| Rate for Payer: HFN Commercial |
$3,124.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,547.00
|
| Rate for Payer: Multiplan Commercial |
$2,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,124.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.04
|
| Rate for Payer: Quartz Commercial |
$2,207.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,037.60
|
| Rate for Payer: The Alliance Commercial |
$13,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,867.80
|
| Rate for Payer: WPS Commercial |
$2,515.42
|
|
|
STAPLER EEA 21MM EEA21/CEEA21 111983
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2962880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.93 |
| Max. Negotiated Rate |
$4,284.44 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$2,794.20
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
STAPLER EEA 21MM EEA21/CEEA21 111983
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2962880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.96 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,303.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,027.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,328.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,606.06
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,492.75
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$3,027.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,794.20
|
| Rate for Payer: The Alliance Commercial |
$18,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
STAPLER EEA 25MM - 4.8MM CIRCULAR EEA25
|
Facility
|
IP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.64 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER EEA 25MM - 4.8MM CIRCULAR EEA25
|
Facility
|
OP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$19,344.00 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,143.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,321.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,706.23
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,627.00
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$3,143.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,901.60
|
| Rate for Payer: The Alliance Commercial |
$19,344.00
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER EEA 28MM - 4.8MM CIRCULAR EEA28
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,580.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,590.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,760.00
|
| Rate for Payer: Health EOS Commercial |
$2,670.00
|
| Rate for Payer: HFN Commercial |
$2,760.00
|
| Rate for Payer: Multiplan Commercial |
$2,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,760.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.00
|
| Rate for Payer: Quartz Commercial |
$1,800.00
|
| Rate for Payer: WEA Trust Commercial |
$1,650.00
|
| Rate for Payer: WPS Commercial |
$2,222.10
|
|
|
STAPLER EEA 28MM - 4.8MM CIRCULAR EEA28
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$12,000.00 |
| Rate for Payer: Aetna Commercial |
$2,700.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,580.00
|
| Rate for Payer: Aetna Managed Medicare |
$840.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,950.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,590.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$2,760.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,678.80
|
| Rate for Payer: Health EOS Commercial |
$2,670.00
|
| Rate for Payer: HFN Commercial |
$2,760.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.00
|
| Rate for Payer: Multiplan Commercial |
$2,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,760.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.00
|
| Rate for Payer: Quartz Commercial |
$1,950.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,800.00
|
| Rate for Payer: The Alliance Commercial |
$12,000.00
|
| Rate for Payer: WEA Trust Commercial |
$1,650.00
|
| Rate for Payer: WPS Commercial |
$2,222.10
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE BLACK TRIEEA28XT
|
Facility
|
IP
|
$7,525.00
|
|
| Hospital Charge Code |
5563652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,687.25 |
| Max. Negotiated Rate |
$6,923.00 |
| Rate for Payer: Aetna Commercial |
$6,772.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,471.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,988.25
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$6,923.00
|
| Rate for Payer: Health EOS Commercial |
$6,697.25
|
| Rate for Payer: HFN Commercial |
$6,923.00
|
| Rate for Payer: Multiplan Commercial |
$6,020.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,515.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,923.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,687.25
|
| Rate for Payer: Quartz Commercial |
$4,515.00
|
| Rate for Payer: WEA Trust Commercial |
$4,138.75
|
| Rate for Payer: WPS Commercial |
$5,573.77
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE BLACK TRIEEA28XT
|
Facility
|
OP
|
$7,525.00
|
|
| Hospital Charge Code |
5563652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,107.00 |
| Max. Negotiated Rate |
$30,100.00 |
| Rate for Payer: Aetna Commercial |
$6,772.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,471.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,107.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,891.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,762.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,612.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,988.25
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$6,923.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,210.99
|
| Rate for Payer: Health EOS Commercial |
$6,697.25
|
| Rate for Payer: HFN Commercial |
$6,923.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,643.75
|
| Rate for Payer: Multiplan Commercial |
$6,020.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,515.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,923.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,687.25
|
| Rate for Payer: Quartz Commercial |
$4,891.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,515.00
|
| Rate for Payer: The Alliance Commercial |
$30,100.00
|
| Rate for Payer: WEA Trust Commercial |
$4,138.75
|
| Rate for Payer: WPS Commercial |
$5,573.77
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE PURPLE TRIEEA28MT
|
Facility
|
IP
|
$762.00
|
|
| Hospital Charge Code |
5520732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$701.04 |
| Rate for Payer: Aetna Commercial |
$685.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.86
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$701.04
|
| Rate for Payer: Health EOS Commercial |
$678.18
|
| Rate for Payer: HFN Commercial |
$701.04
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: NAPHCARE Commercial |
$457.20
|
| Rate for Payer: Preferred Network Access Commercial |
$701.04
|
| Rate for Payer: Quartz Beloit One Network |
$373.38
|
| Rate for Payer: Quartz Commercial |
$457.20
|
| Rate for Payer: WEA Trust Commercial |
$419.10
|
| Rate for Payer: WPS Commercial |
$564.41
|
|
|
STAPLER EEA 28MM CIRCULAR TRI-STAPLE PURPLE TRIEEA28MT
|
Facility
|
OP
|
$762.00
|
|
| Hospital Charge Code |
5520732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.36 |
| Max. Negotiated Rate |
$3,048.00 |
| Rate for Payer: Aetna Commercial |
$685.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.32
|
| Rate for Payer: Aetna Managed Medicare |
$213.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.86
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$701.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.42
|
| Rate for Payer: Health EOS Commercial |
$678.18
|
| Rate for Payer: HFN Commercial |
$701.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.50
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: NAPHCARE Commercial |
$457.20
|
| Rate for Payer: Preferred Network Access Commercial |
$701.04
|
| Rate for Payer: Quartz Beloit One Network |
$373.38
|
| Rate for Payer: Quartz Commercial |
$495.30
|
| Rate for Payer: Quartz Medicare Advantage |
$457.20
|
| Rate for Payer: The Alliance Commercial |
$3,048.00
|
| Rate for Payer: WEA Trust Commercial |
$419.10
|
| Rate for Payer: WPS Commercial |
$564.41
|
|
|
STAPLER EEA 31MM - 4.8MM CIRCULAR EEA31
|
Facility
|
IP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.64 |
| Max. Negotiated Rate |
$4,449.12 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$2,901.60
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER EEA 31MM - 4.8MM CIRCULAR EEA31
|
Facility
|
OP
|
$4,836.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2962869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$19,344.00 |
| Rate for Payer: Aetna Commercial |
$4,352.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,158.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,143.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,321.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,563.08
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$4,449.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,706.23
|
| Rate for Payer: Health EOS Commercial |
$4,304.04
|
| Rate for Payer: HFN Commercial |
$4,449.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,627.00
|
| Rate for Payer: Multiplan Commercial |
$3,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,901.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,449.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,369.64
|
| Rate for Payer: Quartz Commercial |
$3,143.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,901.60
|
| Rate for Payer: The Alliance Commercial |
$19,344.00
|
| Rate for Payer: WEA Trust Commercial |
$2,659.80
|
| Rate for Payer: WPS Commercial |
$3,582.03
|
|
|
STAPLER ENDO GIA 12MM SNGL USE
|
Facility
|
IP
|
$3,517.00
|
|
| Hospital Charge Code |
2962965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,723.33 |
| Max. Negotiated Rate |
$3,235.64 |
| Rate for Payer: Aetna Commercial |
$3,165.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,024.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.01
|
| Rate for Payer: Cash Price |
$1,055.10
|
| Rate for Payer: Cigna Commercial |
$3,235.64
|
| Rate for Payer: Health EOS Commercial |
$3,130.13
|
| Rate for Payer: HFN Commercial |
$3,235.64
|
| Rate for Payer: Multiplan Commercial |
$2,813.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,110.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,235.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.33
|
| Rate for Payer: Quartz Commercial |
$2,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,934.35
|
| Rate for Payer: WPS Commercial |
$2,605.04
|
|
