|
LIGASURE 10MM LAPAROSCOPIC SEAL LS1037
|
Facility
|
OP
|
$5,028.00
|
|
| Hospital Charge Code |
2975073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,407.84 |
| Max. Negotiated Rate |
$20,112.00 |
| Rate for Payer: Aetna Commercial |
$4,525.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,407.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,268.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,413.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,664.84
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,625.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,813.67
|
| Rate for Payer: Health EOS Commercial |
$4,474.92
|
| Rate for Payer: HFN Commercial |
$4,625.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,771.00
|
| Rate for Payer: Multiplan Commercial |
$4,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,016.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,625.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.72
|
| Rate for Payer: Quartz Commercial |
$3,268.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,016.80
|
| Rate for Payer: The Alliance Commercial |
$20,112.00
|
| Rate for Payer: WEA Trust Commercial |
$2,765.40
|
| Rate for Payer: WPS Commercial |
$3,724.24
|
|
|
LIGASURE 20CM OPEN SEALER LS1020
|
Facility
|
IP
|
$4,842.00
|
|
| Hospital Charge Code |
2965820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,372.58 |
| Max. Negotiated Rate |
$4,454.64 |
| Rate for Payer: Aetna Commercial |
$4,357.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,164.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.26
|
| Rate for Payer: Cash Price |
$1,452.60
|
| Rate for Payer: Cigna Commercial |
$4,454.64
|
| Rate for Payer: Health EOS Commercial |
$4,309.38
|
| Rate for Payer: HFN Commercial |
$4,454.64
|
| Rate for Payer: Multiplan Commercial |
$3,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,454.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,372.58
|
| Rate for Payer: Quartz Commercial |
$2,905.20
|
| Rate for Payer: WEA Trust Commercial |
$2,663.10
|
| Rate for Payer: WPS Commercial |
$3,586.47
|
|
|
LIGASURE 20CM OPEN SEALER LS1020
|
Facility
|
OP
|
$4,842.00
|
|
| Hospital Charge Code |
2965820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,355.76 |
| Max. Negotiated Rate |
$19,368.00 |
| Rate for Payer: Aetna Commercial |
$4,357.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,164.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,355.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,147.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.26
|
| Rate for Payer: Cash Price |
$1,452.60
|
| Rate for Payer: Cigna Commercial |
$4,454.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,709.58
|
| Rate for Payer: Health EOS Commercial |
$4,309.38
|
| Rate for Payer: HFN Commercial |
$4,454.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,631.50
|
| Rate for Payer: Multiplan Commercial |
$3,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,454.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,372.58
|
| Rate for Payer: Quartz Commercial |
$3,147.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.20
|
| Rate for Payer: The Alliance Commercial |
$19,368.00
|
| Rate for Payer: WEA Trust Commercial |
$2,663.10
|
| Rate for Payer: WPS Commercial |
$3,586.47
|
|
|
LIGASURE 5MM BLUNT TIP SEALER 37CM LF1837
|
Facility
|
OP
|
$5,437.00
|
|
| Hospital Charge Code |
5306684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,522.36 |
| Max. Negotiated Rate |
$21,748.00 |
| Rate for Payer: Aetna Commercial |
$4,893.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,675.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,522.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,534.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,718.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,609.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,881.61
|
| Rate for Payer: Cash Price |
$1,631.10
|
| Rate for Payer: Cigna Commercial |
$5,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,042.55
|
| Rate for Payer: Health EOS Commercial |
$4,838.93
|
| Rate for Payer: HFN Commercial |
$5,002.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,077.75
|
| Rate for Payer: Multiplan Commercial |
$4,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,664.13
|
| Rate for Payer: Quartz Commercial |
$3,534.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,262.20
|
| Rate for Payer: The Alliance Commercial |
$21,748.00
|
| Rate for Payer: WEA Trust Commercial |
$2,990.35
|
| Rate for Payer: WPS Commercial |
$4,027.19
|
|
|
LIGASURE 5MM BLUNT TIP SEALER 37CM LF1837
|
Facility
|
IP
|
$5,437.00
|
|
| Hospital Charge Code |
5306684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,664.13 |
| Max. Negotiated Rate |
$5,002.04 |
| Rate for Payer: Aetna Commercial |
$4,893.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,675.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,881.61
|
| Rate for Payer: Cash Price |
$1,631.10
|
| Rate for Payer: Cigna Commercial |
$5,002.04
|
| Rate for Payer: Health EOS Commercial |
$4,838.93
|
| Rate for Payer: HFN Commercial |
$5,002.04
|
| Rate for Payer: Multiplan Commercial |
$4,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,664.13
|
| Rate for Payer: Quartz Commercial |
$3,262.20
|
| Rate for Payer: WEA Trust Commercial |
$2,990.35
|
| Rate for Payer: WPS Commercial |
$4,027.19
|
|
|
LIGASURE 5MM L-HOOK LF5637
|
Facility
|
OP
|
$6,768.00
|
|
| Hospital Charge Code |
5178775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,895.04 |
| Max. Negotiated Rate |
$27,072.00 |
| Rate for Payer: Aetna Commercial |
$6,091.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,820.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,895.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,399.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,384.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,587.04
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna Commercial |
$6,226.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,787.37
|
| Rate for Payer: Health EOS Commercial |
$6,023.52
|
| Rate for Payer: HFN Commercial |
$6,226.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,076.00
|
| Rate for Payer: Multiplan Commercial |
$5,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,060.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,226.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.32
|
| Rate for Payer: Quartz Commercial |
$4,399.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,060.80
|
| Rate for Payer: The Alliance Commercial |
$27,072.00
|
| Rate for Payer: WEA Trust Commercial |
$3,722.40
|
| Rate for Payer: WPS Commercial |
$5,013.06
|
|
|
LIGASURE 5MM L-HOOK LF5637
|
Facility
|
IP
|
$6,768.00
|
|
| Hospital Charge Code |
5178775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,316.32 |
| Max. Negotiated Rate |
$6,226.56 |
| Rate for Payer: Aetna Commercial |
$6,091.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,820.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,587.04
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna Commercial |
$6,226.56
|
| Rate for Payer: Health EOS Commercial |
$6,023.52
|
| Rate for Payer: HFN Commercial |
$6,226.56
|
| Rate for Payer: Multiplan Commercial |
$5,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,060.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,226.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.32
|
| Rate for Payer: Quartz Commercial |
$4,060.80
|
| Rate for Payer: WEA Trust Commercial |
$3,722.40
|
| Rate for Payer: WPS Commercial |
$5,013.06
|
|
|
LIGASURE 5MM MARYLAND DISSECTOR/SEALER LF1937
|
Facility
|
OP
|
$5,488.00
|
|
| Hospital Charge Code |
4462802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,536.64 |
| Max. Negotiated Rate |
$21,952.00 |
| Rate for Payer: Aetna Commercial |
$4,939.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,536.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,567.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,744.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,634.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.64
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,048.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,071.08
|
| Rate for Payer: Health EOS Commercial |
$4,884.32
|
| Rate for Payer: HFN Commercial |
$5,048.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,116.00
|
| Rate for Payer: Multiplan Commercial |
$4,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,048.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.12
|
| Rate for Payer: Quartz Commercial |
$3,567.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,292.80
|
| Rate for Payer: The Alliance Commercial |
$21,952.00
|
| Rate for Payer: WEA Trust Commercial |
$3,018.40
|
| Rate for Payer: WPS Commercial |
$4,064.96
|
|
|
LIGASURE 5MM MARYLAND DISSECTOR/SEALER LF1937
|
Facility
|
IP
|
$5,488.00
|
|
| Hospital Charge Code |
4462802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,689.12 |
| Max. Negotiated Rate |
$5,048.96 |
| Rate for Payer: Aetna Commercial |
$4,939.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.64
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,048.96
|
| Rate for Payer: Health EOS Commercial |
$4,884.32
|
| Rate for Payer: HFN Commercial |
$5,048.96
|
| Rate for Payer: Multiplan Commercial |
$4,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,048.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.12
|
| Rate for Payer: Quartz Commercial |
$3,292.80
|
| Rate for Payer: WEA Trust Commercial |
$3,018.40
|
| Rate for Payer: WPS Commercial |
$4,064.96
|
|
|
LIGASURE EXACT LF2019
|
Facility
|
OP
|
$4,219.00
|
|
| Hospital Charge Code |
5659633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,181.32 |
| Max. Negotiated Rate |
$16,876.00 |
| Rate for Payer: Aetna Commercial |
$3,797.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,628.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,181.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,742.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,109.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,025.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.07
|
| Rate for Payer: Cash Price |
$1,265.70
|
| Rate for Payer: Cigna Commercial |
$3,881.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,360.95
|
| Rate for Payer: Health EOS Commercial |
$3,754.91
|
| Rate for Payer: HFN Commercial |
$3,881.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,164.25
|
| Rate for Payer: Multiplan Commercial |
$3,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,531.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,881.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.31
|
| Rate for Payer: Quartz Commercial |
$2,742.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,531.40
|
| Rate for Payer: The Alliance Commercial |
$16,876.00
|
| Rate for Payer: WEA Trust Commercial |
$2,320.45
|
| Rate for Payer: WPS Commercial |
$3,125.01
|
|
|
LIGASURE EXACT LF2019
|
Facility
|
IP
|
$4,219.00
|
|
| Hospital Charge Code |
5659633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,067.31 |
| Max. Negotiated Rate |
$3,881.48 |
| Rate for Payer: Aetna Commercial |
$3,797.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,628.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.07
|
| Rate for Payer: Cash Price |
$1,265.70
|
| Rate for Payer: Cigna Commercial |
$3,881.48
|
| Rate for Payer: Health EOS Commercial |
$3,754.91
|
| Rate for Payer: HFN Commercial |
$3,881.48
|
| Rate for Payer: Multiplan Commercial |
$3,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,531.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,881.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.31
|
| Rate for Payer: Quartz Commercial |
$2,531.40
|
| Rate for Payer: WEA Trust Commercial |
$2,320.45
|
| Rate for Payer: WPS Commercial |
$3,125.01
|
|
|
LIGASURE IMPACT OPEN SEAL LF4418
|
Facility
|
IP
|
$7,377.00
|
|
| Hospital Charge Code |
2965821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,614.73 |
| Max. Negotiated Rate |
$6,786.84 |
| Rate for Payer: Aetna Commercial |
$6,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,344.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.81
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cigna Commercial |
$6,786.84
|
| Rate for Payer: Health EOS Commercial |
$6,565.53
|
| Rate for Payer: HFN Commercial |
$6,786.84
|
| Rate for Payer: Multiplan Commercial |
$5,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.73
|
| Rate for Payer: Quartz Commercial |
$4,426.20
|
| Rate for Payer: WEA Trust Commercial |
$4,057.35
|
| Rate for Payer: WPS Commercial |
$5,464.14
|
|
|
LIGASURE IMPACT OPEN SEAL LF4418
|
Facility
|
OP
|
$7,377.00
|
|
| Hospital Charge Code |
2965821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,065.56 |
| Max. Negotiated Rate |
$29,508.00 |
| Rate for Payer: Aetna Commercial |
$6,639.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,344.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,065.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,795.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,688.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,540.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.81
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cigna Commercial |
$6,786.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.17
|
| Rate for Payer: Health EOS Commercial |
$6,565.53
|
| Rate for Payer: HFN Commercial |
$6,786.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,532.75
|
| Rate for Payer: Multiplan Commercial |
$5,901.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.73
|
| Rate for Payer: Quartz Commercial |
$4,795.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,426.20
|
| Rate for Payer: The Alliance Commercial |
$29,508.00
|
| Rate for Payer: WEA Trust Commercial |
$4,057.35
|
| Rate for Payer: WPS Commercial |
$5,464.14
|
|
|
LIGASURE MARYLAND XP JAW LAP SEALER/DIVIDER ONE-STEP LXMJ37S
|
Facility
|
OP
|
$3,671.00
|
|
| Hospital Charge Code |
6217137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,027.88 |
| Max. Negotiated Rate |
$14,684.00 |
| Rate for Payer: Aetna Commercial |
$3,303.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,157.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,027.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,386.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,835.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,762.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,945.63
|
| Rate for Payer: Cash Price |
$1,101.30
|
| Rate for Payer: Cigna Commercial |
$3,377.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,054.29
|
| Rate for Payer: Health EOS Commercial |
$3,267.19
|
| Rate for Payer: HFN Commercial |
$3,377.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,753.25
|
| Rate for Payer: Multiplan Commercial |
$2,936.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,202.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,377.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,798.79
|
| Rate for Payer: Quartz Commercial |
$2,386.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,202.60
|
| Rate for Payer: The Alliance Commercial |
$14,684.00
|
| Rate for Payer: WEA Trust Commercial |
$2,019.05
|
| Rate for Payer: WPS Commercial |
$2,719.11
|
|
|
LIGASURE MARYLAND XP JAW LAP SEALER/DIVIDER ONE-STEP LXMJ37S
|
Facility
|
IP
|
$3,671.00
|
|
| Hospital Charge Code |
6217137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,798.79 |
| Max. Negotiated Rate |
$3,377.32 |
| Rate for Payer: Aetna Commercial |
$3,303.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,157.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,945.63
|
| Rate for Payer: Cash Price |
$1,101.30
|
| Rate for Payer: Cigna Commercial |
$3,377.32
|
| Rate for Payer: Health EOS Commercial |
$3,267.19
|
| Rate for Payer: HFN Commercial |
$3,377.32
|
| Rate for Payer: Multiplan Commercial |
$2,936.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,202.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,377.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,798.79
|
| Rate for Payer: Quartz Commercial |
$2,202.60
|
| Rate for Payer: WEA Trust Commercial |
$2,019.05
|
| Rate for Payer: WPS Commercial |
$2,719.11
|
|
|
LIGASURE SMALL JAW LF1212A
|
Facility
|
OP
|
$5,474.00
|
|
| Hospital Charge Code |
4153184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,532.72 |
| Max. Negotiated Rate |
$21,896.00 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,558.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,737.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.25
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.50
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,558.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.40
|
| Rate for Payer: The Alliance Commercial |
$21,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LIGASURE SMALL JAW LF1212A
|
Facility
|
IP
|
$5,474.00
|
|
| Hospital Charge Code |
4153184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,682.26 |
| Max. Negotiated Rate |
$5,036.08 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,284.40
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LIGASURE TONSILLECTOMY DEVICE BIZACT 12MM X 12CM BIPOLAR TISSUE SEALER/DIVIDER BZ4212A
|
Facility
|
OP
|
$2,902.00
|
|
| Hospital Charge Code |
6123643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
LIGASURE TONSILLECTOMY DEVICE BIZACT 12MM X 12CM BIPOLAR TISSUE SEALER/DIVIDER BZ4212A
|
Facility
|
IP
|
$2,902.00
|
|
| Hospital Charge Code |
6123643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
LIGATE/DIVIDE/EXCISE VEIN 37785
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
3014578
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$993.70 |
| Rate for Payer: Aetna Commercial |
$993.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.56
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cigna Commercial |
$993.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.60
|
| Rate for Payer: Health EOS Commercial |
$951.86
|
| Rate for Payer: HFN Commercial |
$993.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.37
|
| Rate for Payer: Multiplan Commercial |
$836.80
|
| Rate for Payer: Preferred Network Access Commercial |
$993.70
|
| Rate for Payer: Quartz Beloit One Network |
$460.24
|
| Rate for Payer: Quartz Commercial |
$596.22
|
| Rate for Payer: The Alliance Commercial |
$523.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$575.30
|
| Rate for Payer: WPS Commercial |
$774.77
|
|
|
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 37700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 37722
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
LIGATION OF HEMORRHOIDS 46945
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
CPT 46945
|
| Hospital Charge Code |
3014850
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$1,146.23 |
| Rate for Payer: Aetna Commercial |
$394.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.00
|
| Rate for Payer: Health EOS Commercial |
$377.65
|
| Rate for Payer: HFN Commercial |
$394.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,146.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,146.23
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Preferred Network Access Commercial |
$394.25
|
| Rate for Payer: Quartz Beloit One Network |
$182.60
|
| Rate for Payer: Quartz Commercial |
$236.55
|
| Rate for Payer: The Alliance Commercial |
$207.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
LIGATION OF HEMORRHOIDS 46946
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
3014851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$262.79 |
| Max. Negotiated Rate |
$1,290.25 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.20
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$684.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.00
|
| Rate for Payer: Health EOS Commercial |
$655.20
|
| Rate for Payer: HFN Commercial |
$684.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,290.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,290.25
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Preferred Network Access Commercial |
$684.00
|
| Rate for Payer: Quartz Beloit One Network |
$316.80
|
| Rate for Payer: Quartz Commercial |
$410.40
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: United Healthcare Medicaid |
$262.79
|
| Rate for Payer: WEA Trust Commercial |
$396.00
|
| Rate for Payer: WPS Commercial |
$533.30
|
|
|
Ligation or Biopsy; Temporal Artery
|
Professional
|
Both
|
$1,236.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
1190867
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.81 |
| Max. Negotiated Rate |
$1,174.20 |
| Rate for Payer: Aetna Commercial |
$1,174.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.96
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,174.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.60
|
| Rate for Payer: Health EOS Commercial |
$1,124.76
|
| Rate for Payer: HFN Commercial |
$1,174.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$669.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$669.01
|
| Rate for Payer: Multiplan Commercial |
$988.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,174.20
|
| Rate for Payer: Quartz Beloit One Network |
$543.84
|
| Rate for Payer: Quartz Commercial |
$704.52
|
| Rate for Payer: The Alliance Commercial |
$618.00
|
| Rate for Payer: United Healthcare Medicaid |
$186.81
|
| Rate for Payer: WEA Trust Commercial |
$679.80
|
| Rate for Payer: WPS Commercial |
$915.51
|
|
