|
KYPHOPLASTY THORACIC
|
Facility
|
IP
|
$2,540.00
|
|
| Hospital Charge Code |
6180103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,294.38 |
| Max. Negotiated Rate |
$2,430.27 |
| Rate for Payer: Aetna Commercial |
$2,377.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.05
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$2,430.27
|
| Rate for Payer: Health EOS Commercial |
$2,351.02
|
| Rate for Payer: HFN Commercial |
$2,430.27
|
| Rate for Payer: Multiplan Commercial |
$2,113.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,430.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.38
|
| Rate for Payer: Quartz Commercial |
$1,584.96
|
| Rate for Payer: WEA Trust Commercial |
$1,452.88
|
| Rate for Payer: WPS Commercial |
$1,956.56
|
|
|
KYPHOPLASTY THORACIC
|
Facility
|
OP
|
$2,540.00
|
|
| Hospital Charge Code |
6180103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$739.65 |
| Max. Negotiated Rate |
$2,430.27 |
| Rate for Payer: Aetna Commercial |
$2,377.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.78
|
| Rate for Payer: Aetna Managed Medicare |
$739.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,717.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,320.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,267.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,400.05
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$2,430.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,478.28
|
| Rate for Payer: Health EOS Commercial |
$2,351.02
|
| Rate for Payer: HFN Commercial |
$2,430.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,981.20
|
| Rate for Payer: Multiplan Commercial |
$2,113.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,584.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,430.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.38
|
| Rate for Payer: Quartz Commercial |
$1,717.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,584.96
|
| Rate for Payer: The Alliance Commercial |
$1,320.80
|
| Rate for Payer: WEA Trust Commercial |
$1,452.88
|
| Rate for Payer: WPS Commercial |
$1,956.56
|
|
|
KYPHOPLASTY THORACIC ADD LEVEL
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
6180101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$649.23 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
KYPHOPLASTY THORACIC ADD LEVEL
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
6180101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
LABELS AND MARKER STERILE 3334-P
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2962812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
LABELS AND MARKER STERILE 3334-P
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2962812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
LABOR AND DELIVERY RELATED DIAGNOSES
|
Facility
|
OP
|
$82.55
|
|
|
Service Code
|
EAPG 00760
|
| Min. Negotiated Rate |
$79.37 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Anthem Medicaid |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$79.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.37
|
| Rate for Payer: Dean Health Medicaid |
$79.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$79.37
|
| Rate for Payer: Managed Health Services Medicaid |
$82.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$79.37
|
| Rate for Payer: United Healthcare Medicaid |
$79.37
|
|
|
LABRALTAPE 1.5MM WHITE/BLACK AR-7276T
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
5107166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.18 |
| Max. Negotiated Rate |
$1,176.86 |
| Rate for Payer: Aetna Commercial |
$1,151.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.11
|
| Rate for Payer: Aetna Managed Medicare |
$358.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$831.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$639.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.98
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$1,176.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.86
|
| Rate for Payer: Health EOS Commercial |
$1,138.49
|
| Rate for Payer: HFN Commercial |
$1,176.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$959.40
|
| Rate for Payer: Multiplan Commercial |
$1,023.36
|
| Rate for Payer: NAPHCARE Commercial |
$767.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.86
|
| Rate for Payer: Quartz Beloit One Network |
$626.81
|
| Rate for Payer: Quartz Commercial |
$831.48
|
| Rate for Payer: Quartz Medicare Advantage |
$767.52
|
| Rate for Payer: The Alliance Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$703.56
|
| Rate for Payer: WPS Commercial |
$947.47
|
|
|
LABRALTAPE 1.5MM WHITE/BLACK AR-7276T
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
5107166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$1,176.86 |
| Rate for Payer: Aetna Commercial |
$1,151.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.98
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$1,176.86
|
| Rate for Payer: Health EOS Commercial |
$1,138.49
|
| Rate for Payer: HFN Commercial |
$1,176.86
|
| Rate for Payer: Multiplan Commercial |
$1,023.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.86
|
| Rate for Payer: Quartz Beloit One Network |
$626.81
|
| Rate for Payer: Quartz Commercial |
$767.52
|
| Rate for Payer: WEA Trust Commercial |
$703.56
|
| Rate for Payer: WPS Commercial |
$947.47
|
|
|
LABYRINTHECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LABYRINTHECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Lacosamide
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Lacosamide
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Lacosamide
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983298
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Lacrimal Closure by plug, each
|
Professional
|
Both
|
$403.00
|
|
|
Service Code
|
CPT 68761
|
| Hospital Charge Code |
1188912
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.28 |
| Max. Negotiated Rate |
$466.13 |
| Rate for Payer: Aetna Commercial |
$398.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$360.44
|
| Rate for Payer: Aetna Managed Medicare |
$103.58
|
| Rate for Payer: Anthem Medicare Advantage |
$103.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.58
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cash Price |
$120.90
|
| Rate for Payer: Cigna Commercial |
$398.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.58
|
| Rate for Payer: Health EOS Commercial |
$381.40
|
| Rate for Payer: HFN Commercial |
$398.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$413.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.58
|
| Rate for Payer: Multiplan Commercial |
$335.30
|
| Rate for Payer: NAPHCARE Commercial |
$155.38
|
| Rate for Payer: Preferred Network Access Commercial |
$398.16
|
| Rate for Payer: Quartz Beloit One Network |
$184.41
|
| Rate for Payer: Quartz Commercial |
$238.90
|
| Rate for Payer: Quartz Medicare Advantage |
$103.58
|
| Rate for Payer: The Alliance Commercial |
$440.23
|
| Rate for Payer: United Healthcare Medicaid |
$99.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$230.52
|
| Rate for Payer: WPS Commercial |
$466.13
|
|
|
Lacrimal Closure by plug, each 6876150
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
CPT 68761
|
| Hospital Charge Code |
5174607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.28 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Aetna Managed Medicare |
$103.58
|
| Rate for Payer: Anthem Medicare Advantage |
$103.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.58
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$798.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.58
|
| Rate for Payer: Health EOS Commercial |
$764.69
|
| Rate for Payer: HFN Commercial |
$798.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$413.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.58
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: NAPHCARE Commercial |
$155.38
|
| Rate for Payer: Preferred Network Access Commercial |
$798.30
|
| Rate for Payer: Quartz Beloit One Network |
$369.74
|
| Rate for Payer: Quartz Commercial |
$478.98
|
| Rate for Payer: Quartz Medicare Advantage |
$103.58
|
| Rate for Payer: The Alliance Commercial |
$440.23
|
| Rate for Payer: United Healthcare Medicaid |
$99.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$466.13
|
|
|
LACRIMAL DUCT, IRRIGATION/PROBING/LACERATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960167
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LACRIMAL DUCT, IRRIGATION/PROBING/LACERATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960167
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Lactate Dehydrogenase
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare PPO |
$110.76
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Lactate Dehydrogenase
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Lactate Dehydrogenase
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
633770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$140.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$140.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$140.30
|
| Rate for Payer: Quartz Beloit One Network |
$64.98
|
| Rate for Payer: Quartz Commercial |
$84.18
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$24.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$27.64
|
|
|
Lactate Dehydrogenase Interpretation
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2942935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$214.40 |
| Rate for Payer: Aetna Commercial |
$214.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$13.30
|
| Rate for Payer: Anthem Medicare Advantage |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.30
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.30
|
| Rate for Payer: Health EOS Commercial |
$205.37
|
| Rate for Payer: HFN Commercial |
$214.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.30
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$19.95
|
| Rate for Payer: Preferred Network Access Commercial |
$214.40
|
| Rate for Payer: Quartz Beloit One Network |
$99.30
|
| Rate for Payer: Quartz Commercial |
$128.64
|
| Rate for Payer: Quartz Medicare Advantage |
$13.30
|
| Rate for Payer: The Alliance Commercial |
$52.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.30
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$58.53
|
|
|
Lactate Dehydrogenase Interpretation
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2942935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Lactate Dehydrogenase Interpretation
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
2942935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$13.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.30
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.30
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.30
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$19.95
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$13.30
|
| Rate for Payer: The Alliance Commercial |
$53.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.30
|
| Rate for Payer: United Healthcare PPO |
$169.26
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$13.30
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Lactate Dehydrogenase Isoenzyme Panel
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
983299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare PPO |
$107.64
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
