|
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
|
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 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 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 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 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
|
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 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 (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) 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) 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 (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 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
|
|
|
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 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 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 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 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 30-3.5 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-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
|
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
|
|
