|
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
|
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 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 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
|
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 60-3.8
|
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: HFN Commercial |
$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: 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 60-4.8 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 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 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 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 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 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 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
|
|
|
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
|
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 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
|
|
