|
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
|
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 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 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 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 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 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 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
|
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
|
|
|
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
|
|
|
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, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 37718
|
|
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, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); ABDOMEN
|
Facility
|
OP
|
$23,424.04
|
|
|
Service Code
|
CPT 37617
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| 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 |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
|
|
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 37618
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,378.29 |
| Max. Negotiated Rate |
$12,349.86 |
| 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: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$1,378.29
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
|
|
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
|
|
|
LIGATION OF HEMORRHOIDS 46946
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
3014851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$273.30 |
| Max. Negotiated Rate |
$1,681.38 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.97
|
| Rate for Payer: Aetna Managed Medicare |
$373.64
|
| Rate for Payer: Anthem Medicare Advantage |
$373.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$373.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$373.64
|
| 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 |
$711.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.64
|
| Rate for Payer: Health EOS Commercial |
$681.41
|
| Rate for Payer: HFN Commercial |
$711.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,341.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,341.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$373.64
|
| Rate for Payer: Multiplan Commercial |
$599.04
|
| Rate for Payer: NAPHCARE Commercial |
$560.46
|
| Rate for Payer: Preferred Network Access Commercial |
$711.36
|
| Rate for Payer: Quartz Beloit One Network |
$329.47
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: Quartz Medicare Advantage |
$373.64
|
| Rate for Payer: The Alliance Commercial |
$1,587.97
|
| Rate for Payer: United Healthcare Medicaid |
$273.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.64
|
| Rate for Payer: WEA Trust Commercial |
$411.84
|
| Rate for Payer: WPS Commercial |
$1,681.38
|
|
|
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 |
$177.01 |
| Max. Negotiated Rate |
$1,221.17 |
| Rate for Payer: Aetna Commercial |
$1,221.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.48
|
| Rate for Payer: Aetna Managed Medicare |
$177.01
|
| Rate for Payer: Anthem Medicare Advantage |
$177.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.01
|
| 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 |
$1,221.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$1,169.75
|
| Rate for Payer: HFN Commercial |
$1,221.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$695.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$1,028.35
|
| Rate for Payer: NAPHCARE Commercial |
$265.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.17
|
| Rate for Payer: Quartz Beloit One Network |
$565.59
|
| Rate for Payer: Quartz Commercial |
$732.70
|
| Rate for Payer: Quartz Medicare Advantage |
$177.01
|
| Rate for Payer: The Alliance Commercial |
$752.28
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.01
|
| Rate for Payer: WEA Trust Commercial |
$706.99
|
| Rate for Payer: WPS Commercial |
$796.54
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Liletta 1 unit Charge
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
5571267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Aetna Managed Medicare |
$550.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,278.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$983.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.14
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,475.76
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,278.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.61
|
| Rate for Payer: The Alliance Commercial |
$983.84
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
Liletta 1 unit Charge
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
5571267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.16 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,180.61
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
Liletta 1 unit Charge
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
5571267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$865.78 |
| Max. Negotiated Rate |
$1,869.30 |
| Rate for Payer: Aetna Commercial |
$1,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Anthem Commercial |
$878.90
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,869.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$969.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,180.61
|
| Rate for Payer: Health EOS Commercial |
$1,790.59
|
| Rate for Payer: HFN Commercial |
$1,869.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,315.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,315.29
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.30
|
| Rate for Payer: Quartz Beloit One Network |
$865.78
|
| Rate for Payer: Quartz Commercial |
$1,121.58
|
| Rate for Payer: The Alliance Commercial |
$983.84
|
| Rate for Payer: United Healthcare Medicaid |
$969.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
