|
Lidocaine Injection J2001
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
3975039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Lidocaine Injection J2001
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
3975039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.03
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$0.07
|
|
|
Lidocaine Jelly 10ml Urojet [Med]
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2974958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Lidocaine Jelly 10ml Urojet [Med]
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2974958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Lidocaine Level
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
4598919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$15.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.36
|
| Rate for Payer: Anthem Medicare Advantage |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.28
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.28
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$22.92
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$107.48
|
| Rate for Payer: Quartz Medicare Advantage |
$15.28
|
| Rate for Payer: The Alliance Commercial |
$61.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.28
|
| Rate for Payer: United Healthcare PPO |
$124.02
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: Wellcare Medicare |
$15.28
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Lidocaine Level
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
4598919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$99.22
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Lidocaine Level
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
4598919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$157.09 |
| Rate for Payer: Aetna Commercial |
$157.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$15.28
|
| Rate for Payer: Anthem Medicare Advantage |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.28
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$157.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.28
|
| Rate for Payer: Health EOS Commercial |
$150.48
|
| Rate for Payer: HFN Commercial |
$157.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$22.92
|
| Rate for Payer: Preferred Network Access Commercial |
$157.09
|
| Rate for Payer: Quartz Beloit One Network |
$72.76
|
| Rate for Payer: Quartz Commercial |
$94.26
|
| Rate for Payer: Quartz Medicare Advantage |
$15.28
|
| Rate for Payer: The Alliance Commercial |
$60.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.28
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$67.22
|
|
|
Lidocaine MPF 1% 2ml vial [Med]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
2974896
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.04
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$0.07
|
|
|
Lidocaine MPF 1% 2ml vial [Med]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
2974896
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Lidocaine PF 1% 30ml SDV [Med]
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
5286881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Lidocaine PF 1% 30ml SDV [Med]
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
5286881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.04
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$0.07
|
|
|
lidocaine Top 2% Gel 5 gm [Med]
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
2983103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Aetna Commercial |
$43.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Aetna Managed Medicare |
$13.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.91
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.35
|
| Rate for Payer: Health EOS Commercial |
$43.50
|
| Rate for Payer: HFN Commercial |
$44.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.66
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: NAPHCARE Commercial |
$29.33
|
| Rate for Payer: Preferred Network Access Commercial |
$44.97
|
| Rate for Payer: Quartz Beloit One Network |
$23.95
|
| Rate for Payer: Quartz Commercial |
$31.77
|
| Rate for Payer: Quartz Medicare Advantage |
$29.33
|
| Rate for Payer: The Alliance Commercial |
$24.44
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$36.20
|
|
|
lidocaine Top 2% Gel 5 gm [Med]
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
2983103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Aetna Commercial |
$43.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.91
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.97
|
| Rate for Payer: Health EOS Commercial |
$43.50
|
| Rate for Payer: HFN Commercial |
$44.97
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: Preferred Network Access Commercial |
$44.97
|
| Rate for Payer: Quartz Beloit One Network |
$23.95
|
| Rate for Payer: Quartz Commercial |
$29.33
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$36.20
|
|
|
Li-Fraumuni Syndrome
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5426837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$402.58 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
Li-Fraumuni Syndrome
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5426837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$1,253.62 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$313.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,175.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.25
|
| Rate for Payer: Anthem Medicare Advantage |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.40
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$313.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$313.40
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$313.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$313.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$313.40
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$470.11
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| Rate for Payer: Quartz Medicare Advantage |
$313.40
|
| Rate for Payer: The Alliance Commercial |
$1,253.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.40
|
| Rate for Payer: United Healthcare PPO |
$616.20
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: Wellcare Medicare |
$313.40
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
Li-Fraumuni Syndrome
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5426837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$1,378.98 |
| Rate for Payer: Aetna Commercial |
$780.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$313.40
|
| Rate for Payer: Anthem Medicare Advantage |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.40
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$780.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.40
|
| Rate for Payer: Health EOS Commercial |
$747.66
|
| Rate for Payer: HFN Commercial |
$780.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,106.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,106.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.40
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$470.11
|
| Rate for Payer: Preferred Network Access Commercial |
$780.52
|
| Rate for Payer: Quartz Beloit One Network |
$361.50
|
| Rate for Payer: Quartz Commercial |
$468.31
|
| Rate for Payer: Quartz Medicare Advantage |
$313.40
|
| Rate for Payer: The Alliance Commercial |
$1,237.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.40
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$1,378.98
|
|
|
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
|
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 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 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 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 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 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 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 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
|
|
