|
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
LIGASURE 10MM LAPAROSCOPIC SEAL LS1037
|
Facility
|
OP
|
$5,028.00
|
|
| Hospital Charge Code |
2975073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,464.15 |
| Max. Negotiated Rate |
$4,810.79 |
| Rate for Payer: Aetna Commercial |
$4,706.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,464.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,398.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,614.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,509.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.43
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,810.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,926.30
|
| Rate for Payer: Health EOS Commercial |
$4,653.92
|
| Rate for Payer: HFN Commercial |
$4,810.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,921.84
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,137.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.27
|
| Rate for Payer: Quartz Commercial |
$3,398.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,137.47
|
| Rate for Payer: The Alliance Commercial |
$2,614.56
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$3,873.07
|
|
|
LIGASURE 10MM LAPAROSCOPIC SEAL LS1037
|
Facility
|
IP
|
$5,028.00
|
|
| Hospital Charge Code |
2975073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,562.27 |
| Max. Negotiated Rate |
$4,810.79 |
| Rate for Payer: Aetna Commercial |
$4,706.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.43
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,810.79
|
| Rate for Payer: Health EOS Commercial |
$4,653.92
|
| Rate for Payer: HFN Commercial |
$4,810.79
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.27
|
| Rate for Payer: Quartz Commercial |
$3,137.47
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$3,873.07
|
|
|
LIGASURE 20CM OPEN SEALER LS1020
|
Facility
|
OP
|
$4,842.00
|
|
| Hospital Charge Code |
2965820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,409.99 |
| Max. Negotiated Rate |
$4,632.83 |
| Rate for Payer: Aetna Commercial |
$4,532.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,330.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,409.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,273.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,517.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,417.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,668.91
|
| Rate for Payer: Cash Price |
$1,452.60
|
| Rate for Payer: Cigna Commercial |
$4,632.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,818.04
|
| Rate for Payer: Health EOS Commercial |
$4,481.76
|
| Rate for Payer: HFN Commercial |
$4,632.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,776.76
|
| Rate for Payer: Multiplan Commercial |
$4,028.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,021.41
|
| Rate for Payer: Preferred Network Access Commercial |
$4,632.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,467.48
|
| Rate for Payer: Quartz Commercial |
$3,273.19
|
| Rate for Payer: Quartz Medicare Advantage |
$3,021.41
|
| Rate for Payer: The Alliance Commercial |
$2,517.84
|
| Rate for Payer: WEA Trust Commercial |
$2,769.62
|
| Rate for Payer: WPS Commercial |
$3,729.79
|
|
|
LIGASURE 20CM OPEN SEALER LS1020
|
Facility
|
IP
|
$4,842.00
|
|
| Hospital Charge Code |
2965820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,467.48 |
| Max. Negotiated Rate |
$4,632.83 |
| Rate for Payer: Aetna Commercial |
$4,532.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,330.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,668.91
|
| Rate for Payer: Cash Price |
$1,452.60
|
| Rate for Payer: Cigna Commercial |
$4,632.83
|
| Rate for Payer: Health EOS Commercial |
$4,481.76
|
| Rate for Payer: HFN Commercial |
$4,632.83
|
| Rate for Payer: Multiplan Commercial |
$4,028.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,632.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,467.48
|
| Rate for Payer: Quartz Commercial |
$3,021.41
|
| Rate for Payer: WEA Trust Commercial |
$2,769.62
|
| Rate for Payer: WPS Commercial |
$3,729.79
|
|
|
LIGASURE 5MM BLUNT TIP SEALER 37CM LF1837
|
Facility
|
OP
|
$5,437.00
|
|
| Hospital Charge Code |
5306684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,583.25 |
| Max. Negotiated Rate |
$5,202.12 |
| Rate for Payer: Aetna Commercial |
$5,089.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,862.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,583.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,675.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,827.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,714.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,996.87
|
| Rate for Payer: Cash Price |
$1,631.10
|
| Rate for Payer: Cigna Commercial |
$5,202.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,164.33
|
| Rate for Payer: Health EOS Commercial |
$5,032.49
|
| Rate for Payer: HFN Commercial |
$5,202.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,240.86
|
| Rate for Payer: Multiplan Commercial |
$4,523.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,392.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,202.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,770.70
|
| Rate for Payer: Quartz Commercial |
$3,675.41
|
| Rate for Payer: Quartz Medicare Advantage |
$3,392.69
|
| Rate for Payer: The Alliance Commercial |
$2,827.24
|
| Rate for Payer: WEA Trust Commercial |
$3,109.96
|
| Rate for Payer: WPS Commercial |
$4,188.12
|
|
|
LIGASURE 5MM BLUNT TIP SEALER 37CM LF1837
|
Facility
|
IP
|
$5,437.00
|
|
| Hospital Charge Code |
5306684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,770.70 |
| Max. Negotiated Rate |
$5,202.12 |
| Rate for Payer: Aetna Commercial |
$5,089.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,862.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,996.87
|
| Rate for Payer: Cash Price |
$1,631.10
|
| Rate for Payer: Cigna Commercial |
$5,202.12
|
| Rate for Payer: Health EOS Commercial |
$5,032.49
|
| Rate for Payer: HFN Commercial |
$5,202.12
|
| Rate for Payer: Multiplan Commercial |
$4,523.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,202.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,770.70
|
| Rate for Payer: Quartz Commercial |
$3,392.69
|
| Rate for Payer: WEA Trust Commercial |
$3,109.96
|
| Rate for Payer: WPS Commercial |
$4,188.12
|
|
|
LIGASURE 5MM L-HOOK LF5637
|
Facility
|
OP
|
$6,768.00
|
|
| Hospital Charge Code |
5178775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,970.84 |
| Max. Negotiated Rate |
$6,475.62 |
| Rate for Payer: Aetna Commercial |
$6,334.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,053.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,970.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,575.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,519.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,378.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,730.52
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna Commercial |
$6,475.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,938.98
|
| Rate for Payer: Health EOS Commercial |
$6,264.46
|
| Rate for Payer: HFN Commercial |
$6,475.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,279.04
|
| Rate for Payer: Multiplan Commercial |
$5,630.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,223.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,475.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.97
|
| Rate for Payer: Quartz Commercial |
$4,575.17
|
| Rate for Payer: Quartz Medicare Advantage |
$4,223.23
|
| Rate for Payer: The Alliance Commercial |
$3,519.36
|
| Rate for Payer: WEA Trust Commercial |
$3,871.30
|
| Rate for Payer: WPS Commercial |
$5,213.39
|
|
|
LIGASURE 5MM L-HOOK LF5637
|
Facility
|
IP
|
$6,768.00
|
|
| Hospital Charge Code |
5178775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.97 |
| Max. Negotiated Rate |
$6,475.62 |
| Rate for Payer: Aetna Commercial |
$6,334.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,053.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,730.52
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna Commercial |
$6,475.62
|
| Rate for Payer: Health EOS Commercial |
$6,264.46
|
| Rate for Payer: HFN Commercial |
$6,475.62
|
| Rate for Payer: Multiplan Commercial |
$5,630.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,475.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.97
|
| Rate for Payer: Quartz Commercial |
$4,223.23
|
| Rate for Payer: WEA Trust Commercial |
$3,871.30
|
| Rate for Payer: WPS Commercial |
$5,213.39
|
|
|
LIGASURE 5MM MARYLAND DISSECTOR/SEALER LF1937
|
Facility
|
OP
|
$5,488.00
|
|
| Hospital Charge Code |
4462802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,598.11 |
| Max. Negotiated Rate |
$5,250.92 |
| Rate for Payer: Aetna Commercial |
$5,136.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,908.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,598.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,709.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,853.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,739.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,024.99
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,250.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,194.02
|
| Rate for Payer: Health EOS Commercial |
$5,079.69
|
| Rate for Payer: HFN Commercial |
$5,250.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,280.64
|
| Rate for Payer: Multiplan Commercial |
$4,566.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,424.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,250.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,796.68
|
| Rate for Payer: Quartz Commercial |
$3,709.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,424.51
|
| Rate for Payer: The Alliance Commercial |
$2,853.76
|
| Rate for Payer: WEA Trust Commercial |
$3,139.14
|
| Rate for Payer: WPS Commercial |
$4,227.41
|
|
|
LIGASURE 5MM MARYLAND DISSECTOR/SEALER LF1937
|
Facility
|
IP
|
$5,488.00
|
|
| Hospital Charge Code |
4462802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,796.68 |
| Max. Negotiated Rate |
$5,250.92 |
| Rate for Payer: Aetna Commercial |
$5,136.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,908.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,024.99
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,250.92
|
| Rate for Payer: Health EOS Commercial |
$5,079.69
|
| Rate for Payer: HFN Commercial |
$5,250.92
|
| Rate for Payer: Multiplan Commercial |
$4,566.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,250.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,796.68
|
| Rate for Payer: Quartz Commercial |
$3,424.51
|
| Rate for Payer: WEA Trust Commercial |
$3,139.14
|
| Rate for Payer: WPS Commercial |
$4,227.41
|
|
|
LIGASURE EXACT LF2019
|
Facility
|
IP
|
$4,219.00
|
|
| Hospital Charge Code |
5659633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$4,036.74 |
| Rate for Payer: Aetna Commercial |
$3,948.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,773.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,325.51
|
| Rate for Payer: Cash Price |
$1,265.70
|
| Rate for Payer: Cigna Commercial |
$4,036.74
|
| Rate for Payer: Health EOS Commercial |
$3,905.11
|
| Rate for Payer: HFN Commercial |
$4,036.74
|
| Rate for Payer: Multiplan Commercial |
$3,510.21
|
| Rate for Payer: Preferred Network Access Commercial |
$4,036.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,150.00
|
| Rate for Payer: Quartz Commercial |
$2,632.66
|
| Rate for Payer: WEA Trust Commercial |
$2,413.27
|
| Rate for Payer: WPS Commercial |
$3,249.90
|
|
|
LIGASURE EXACT LF2019
|
Facility
|
OP
|
$4,219.00
|
|
| Hospital Charge Code |
5659633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,228.57 |
| Max. Negotiated Rate |
$4,036.74 |
| Rate for Payer: Aetna Commercial |
$3,948.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,773.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,228.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,852.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,193.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,106.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,325.51
|
| Rate for Payer: Cash Price |
$1,265.70
|
| Rate for Payer: Cigna Commercial |
$4,036.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,455.46
|
| Rate for Payer: Health EOS Commercial |
$3,905.11
|
| Rate for Payer: HFN Commercial |
$4,036.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,290.82
|
| Rate for Payer: Multiplan Commercial |
$3,510.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,632.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,036.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,150.00
|
| Rate for Payer: Quartz Commercial |
$2,852.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,632.66
|
| Rate for Payer: The Alliance Commercial |
$2,193.88
|
| Rate for Payer: WEA Trust Commercial |
$2,413.27
|
| Rate for Payer: WPS Commercial |
$3,249.90
|
|
|
LIGASURE IMPACT OPEN SEAL LF4418
|
Facility
|
IP
|
$7,377.00
|
|
| Hospital Charge Code |
2965821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,759.32 |
| Max. Negotiated Rate |
$7,058.31 |
| Rate for Payer: Aetna Commercial |
$6,904.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,597.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,066.20
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cigna Commercial |
$7,058.31
|
| Rate for Payer: Health EOS Commercial |
$6,828.15
|
| Rate for Payer: HFN Commercial |
$7,058.31
|
| Rate for Payer: Multiplan Commercial |
$6,137.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,058.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,759.32
|
| Rate for Payer: Quartz Commercial |
$4,603.25
|
| Rate for Payer: WEA Trust Commercial |
$4,219.64
|
| Rate for Payer: WPS Commercial |
$5,682.50
|
|
|
LIGASURE IMPACT OPEN SEAL LF4418
|
Facility
|
OP
|
$7,377.00
|
|
| Hospital Charge Code |
2965821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,148.18 |
| Max. Negotiated Rate |
$7,058.31 |
| Rate for Payer: Aetna Commercial |
$6,904.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,597.99
|
| Rate for Payer: Aetna Managed Medicare |
$2,148.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,986.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,836.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,682.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,066.20
|
| Rate for Payer: Cash Price |
$2,213.10
|
| Rate for Payer: Cigna Commercial |
$7,058.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,293.41
|
| Rate for Payer: Health EOS Commercial |
$6,828.15
|
| Rate for Payer: HFN Commercial |
$7,058.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,754.06
|
| Rate for Payer: Multiplan Commercial |
$6,137.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,603.25
|
| Rate for Payer: Preferred Network Access Commercial |
$7,058.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,759.32
|
| Rate for Payer: Quartz Commercial |
$4,986.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,603.25
|
| Rate for Payer: The Alliance Commercial |
$3,836.04
|
| Rate for Payer: WEA Trust Commercial |
$4,219.64
|
| Rate for Payer: WPS Commercial |
$5,682.50
|
|
|
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 |
$1,069.00 |
| Max. Negotiated Rate |
$3,512.41 |
| Rate for Payer: Aetna Commercial |
$3,436.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,283.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,069.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,481.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,908.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,832.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,023.46
|
| Rate for Payer: Cash Price |
$1,101.30
|
| Rate for Payer: Cigna Commercial |
$3,512.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,136.52
|
| Rate for Payer: Health EOS Commercial |
$3,397.88
|
| Rate for Payer: HFN Commercial |
$3,512.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,863.38
|
| Rate for Payer: Multiplan Commercial |
$3,054.27
|
| Rate for Payer: NAPHCARE Commercial |
$2,290.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,512.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,870.74
|
| Rate for Payer: Quartz Commercial |
$2,481.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,290.70
|
| Rate for Payer: The Alliance Commercial |
$1,908.92
|
| Rate for Payer: WEA Trust Commercial |
$2,099.81
|
| Rate for Payer: WPS Commercial |
$2,827.77
|
|
|
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 |
$1,870.74 |
| Max. Negotiated Rate |
$3,512.41 |
| Rate for Payer: Aetna Commercial |
$3,436.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,283.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,023.46
|
| Rate for Payer: Cash Price |
$1,101.30
|
| Rate for Payer: Cigna Commercial |
$3,512.41
|
| Rate for Payer: Health EOS Commercial |
$3,397.88
|
| Rate for Payer: HFN Commercial |
$3,512.41
|
| Rate for Payer: Multiplan Commercial |
$3,054.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,512.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,870.74
|
| Rate for Payer: Quartz Commercial |
$2,290.70
|
| Rate for Payer: WEA Trust Commercial |
$2,099.81
|
| Rate for Payer: WPS Commercial |
$2,827.77
|
|
|
LIGASURE SMALL JAW LF1212A
|
Facility
|
OP
|
$5,474.00
|
|
| Hospital Charge Code |
4153184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,594.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,700.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,846.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,732.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.87
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,269.72
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,415.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,700.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,415.78
|
| Rate for Payer: The Alliance Commercial |
$2,846.48
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
LIGASURE SMALL JAW LF1212A
|
Facility
|
IP
|
$5,474.00
|
|
| Hospital Charge Code |
4153184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,789.55 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,415.78
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
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 |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
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 |
$78.34 |
| Max. Negotiated Rate |
$1,033.45 |
| Rate for Payer: Aetna Commercial |
$1,033.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.54
|
| Rate for Payer: Aetna Managed Medicare |
$217.19
|
| Rate for Payer: Anthem Medicare Advantage |
$217.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$217.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$217.19
|
| 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 |
$1,033.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$989.93
|
| Rate for Payer: HFN Commercial |
$1,033.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$862.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$862.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$870.27
|
| Rate for Payer: NAPHCARE Commercial |
$325.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,033.45
|
| Rate for Payer: Quartz Beloit One Network |
$478.65
|
| Rate for Payer: Quartz Commercial |
$620.07
|
| Rate for Payer: Quartz Medicare Advantage |
$217.19
|
| Rate for Payer: The Alliance Commercial |
$923.07
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.19
|
| Rate for Payer: WEA Trust Commercial |
$598.31
|
| Rate for Payer: WPS Commercial |
$977.37
|
|
|
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 37700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 37722
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
LIGATION OF HEMORRHOIDS 46945
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
CPT 46945
|
| Hospital Charge Code |
3014850
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$1,531.53 |
| Rate for Payer: Aetna Commercial |
$410.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Aetna Managed Medicare |
$340.34
|
| Rate for Payer: Anthem Medicare Advantage |
$340.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$340.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$340.34
|
| 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 |
$410.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.34
|
| Rate for Payer: Health EOS Commercial |
$392.76
|
| Rate for Payer: HFN Commercial |
$410.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,192.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$340.34
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: NAPHCARE Commercial |
$510.51
|
| Rate for Payer: Preferred Network Access Commercial |
$410.02
|
| Rate for Payer: Quartz Beloit One Network |
$189.90
|
| Rate for Payer: Quartz Commercial |
$246.01
|
| Rate for Payer: Quartz Medicare Advantage |
$340.34
|
| Rate for Payer: The Alliance Commercial |
$1,446.44
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$340.34
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$1,531.53
|
|
