|
LACRIMAL DUCT, IRRIGATION/PROBING/LACERATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960167
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Lactate Dehydrogenase
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna Commercial |
$134.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$134.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.20
|
| Rate for Payer: Health EOS Commercial |
$129.22
|
| Rate for Payer: HFN Commercial |
$134.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.90
|
| Rate for Payer: Quartz Beloit One Network |
$62.48
|
| Rate for Payer: Quartz Commercial |
$80.94
|
| Rate for Payer: The Alliance Commercial |
$71.00
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Lactate Dehydrogenase
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.46
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$92.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Lactate Dehydrogenase
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$85.20
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Lactate Dehydrogenase Interpretation
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2942935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$12.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.23
|
| Rate for Payer: Anthem Medicaid |
$13.22
|
| Rate for Payer: Anthem Medicare Advantage |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.79
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.43
|
| Rate for Payer: Dean Health Medicaid |
$13.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.79
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.79
|
| Rate for Payer: Managed Health Services Medicaid |
$13.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.79
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.18
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.22
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.79
|
| Rate for Payer: The Alliance Commercial |
$51.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.79
|
| Rate for Payer: United Healthcare PPO |
$162.75
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$12.79
|
| Rate for Payer: WMAP Medicaid |
$13.22
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Lactate Dehydrogenase Interpretation
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2942935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Lactate Dehydrogenase Interpretation
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2942935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna Commercial |
$206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$206.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.20
|
| Rate for Payer: Health EOS Commercial |
$197.47
|
| Rate for Payer: HFN Commercial |
$206.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$206.15
|
| Rate for Payer: Quartz Beloit One Network |
$95.48
|
| Rate for Payer: Quartz Commercial |
$123.69
|
| Rate for Payer: The Alliance Commercial |
$108.50
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Lactate Dehydrogenase Isoenzyme Panel
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
983299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$131.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$125.58
|
| Rate for Payer: HFN Commercial |
$131.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$131.10
|
| Rate for Payer: Quartz Beloit One Network |
$60.72
|
| Rate for Payer: Quartz Commercial |
$78.66
|
| Rate for Payer: The Alliance Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Lactate Dehydrogenase Isoenzyme Panel
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
983299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$103.50
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Lactate Dehydrogenase Isoenzyme Panel
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
983299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Lactated Ringers 1000Cc
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
3101781
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.40
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Lactated Ringers 1000Cc
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
3101781
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Lactate/Pyruvate
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
4578608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.21
|
| Rate for Payer: Anthem Medicaid |
$11.96
|
| Rate for Payer: Anthem Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.57
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Dean Health Medicaid |
$11.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.57
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.57
|
| Rate for Payer: Managed Health Services Medicaid |
$12.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.36
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.96
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.57
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: United Healthcare Medicaid |
$11.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare PPO |
$79.50
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: Wellcare Medicare |
$11.57
|
| Rate for Payer: WMAP Medicaid |
$11.96
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Lactate/Pyruvate
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
4578608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Lactate/Pyruvate
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
4578608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$100.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.60
|
| Rate for Payer: Health EOS Commercial |
$96.46
|
| Rate for Payer: HFN Commercial |
$100.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.84
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Preferred Network Access Commercial |
$100.70
|
| Rate for Payer: Quartz Beloit One Network |
$46.64
|
| Rate for Payer: Quartz Commercial |
$60.42
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Lactic Acid
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
633772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Lactic Acid
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
633772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$180.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$180.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.00
|
| Rate for Payer: Health EOS Commercial |
$172.90
|
| Rate for Payer: HFN Commercial |
$180.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.84
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$180.50
|
| Rate for Payer: Quartz Beloit One Network |
$83.60
|
| Rate for Payer: Quartz Commercial |
$108.30
|
| Rate for Payer: The Alliance Commercial |
$95.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Lactic Acid
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
633772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$11.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.21
|
| Rate for Payer: Anthem Medicaid |
$11.96
|
| Rate for Payer: Anthem Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.57
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Dean Health Medicaid |
$11.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.57
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.57
|
| Rate for Payer: Managed Health Services Medicaid |
$12.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.36
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.96
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$11.57
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: United Healthcare Medicaid |
$11.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare PPO |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: Wellcare Medicare |
$11.57
|
| Rate for Payer: WMAP Medicaid |
$11.96
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Lactoferrin Quant Stool
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
4520608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$19.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.59
|
| Rate for Payer: Anthem Medicaid |
$20.28
|
| Rate for Payer: Anthem Medicare Advantage |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.63
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Dean Health Medicaid |
$20.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.63
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.63
|
| Rate for Payer: Managed Health Services Medicaid |
$21.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$29.44
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.28
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$19.63
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: United Healthcare Medicaid |
$20.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: United Healthcare PPO |
$266.25
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: Wellcare Medicare |
$19.63
|
| Rate for Payer: WMAP Medicaid |
$20.28
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Lactoferrin Quant Stool
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
4520608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Lactoferrin Quant Stool
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
4520608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna Commercial |
$337.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$337.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.00
|
| Rate for Payer: Health EOS Commercial |
$323.05
|
| Rate for Payer: HFN Commercial |
$337.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.29
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Preferred Network Access Commercial |
$337.25
|
| Rate for Payer: Quartz Beloit One Network |
$156.20
|
| Rate for Payer: Quartz Commercial |
$202.35
|
| Rate for Payer: The Alliance Commercial |
$177.50
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
LAFORTE OSTEOTOMY
|
Facility
|
OP
|
$6,808.00
|
|
| Hospital Charge Code |
2960171
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,906.24 |
| Max. Negotiated Rate |
$27,232.00 |
| Rate for Payer: Aetna Commercial |
$6,127.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,854.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,906.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,425.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,404.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,267.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,608.24
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,263.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,809.76
|
| Rate for Payer: Health EOS Commercial |
$6,059.12
|
| Rate for Payer: HFN Commercial |
$6,263.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,106.00
|
| Rate for Payer: Multiplan Commercial |
$5,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,084.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,263.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,335.92
|
| Rate for Payer: Quartz Commercial |
$4,425.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,084.80
|
| Rate for Payer: The Alliance Commercial |
$27,232.00
|
| Rate for Payer: WEA Trust Commercial |
$3,744.40
|
| Rate for Payer: WPS Commercial |
$5,042.69
|
|
|
LAFORTE OSTEOTOMY
|
Facility
|
IP
|
$6,808.00
|
|
| Hospital Charge Code |
2960171
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,335.92 |
| Max. Negotiated Rate |
$6,263.36 |
| Rate for Payer: Aetna Commercial |
$6,127.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,854.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,608.24
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,263.36
|
| Rate for Payer: Health EOS Commercial |
$6,059.12
|
| Rate for Payer: HFN Commercial |
$6,263.36
|
| Rate for Payer: Multiplan Commercial |
$5,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,084.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,263.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,335.92
|
| Rate for Payer: Quartz Commercial |
$4,084.80
|
| Rate for Payer: WEA Trust Commercial |
$3,744.40
|
| Rate for Payer: WPS Commercial |
$5,042.69
|
|
|
LAG SCREW 105MM TFNA FENESTRATED 04.038.205S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.72 |
| Max. Negotiated Rate |
$21,896.00 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,558.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,737.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.25
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.50
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,558.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.40
|
| Rate for Payer: The Alliance Commercial |
$21,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW 105MM TFNA FENESTRATED 04.038.205S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.26 |
| Max. Negotiated Rate |
$5,036.08 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,284.40
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
