|
Lactate Dehydrogenase Isoenzyme Panel
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
983299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Lactate Dehydrogenase Isoenzyme Panel
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
983299
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| 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 |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| 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 |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| 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 |
$78.94
|
| Rate for Payer: WPS Commercial |
$27.64
|
|
|
Lactated Ringers 1000Cc
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
3101781
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Lactated Ringers 1000Cc
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
3101781
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.82
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$43.06
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$43.06
|
| Rate for Payer: The Alliance Commercial |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Lactate/Pyruvate
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
4578608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Lactate/Pyruvate
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
4578608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$104.73 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$12.03
|
| Rate for Payer: Anthem Medicare Advantage |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.03
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$104.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.03
|
| Rate for Payer: Health EOS Commercial |
$100.32
|
| Rate for Payer: HFN Commercial |
$104.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.03
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$18.05
|
| Rate for Payer: Preferred Network Access Commercial |
$104.73
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$62.84
|
| Rate for Payer: Quartz Medicare Advantage |
$12.03
|
| Rate for Payer: The Alliance Commercial |
$47.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.03
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$52.94
|
|
|
Lactate/Pyruvate
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
4578608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$12.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Anthem Medicare Advantage |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.03
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.03
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.03
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$18.05
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$12.03
|
| Rate for Payer: The Alliance Commercial |
$48.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.03
|
| Rate for Payer: United Healthcare PPO |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: Wellcare Medicare |
$12.03
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Lactic Acid
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
633772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Anthem Medicare Advantage |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.03
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.03
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.03
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$18.05
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$12.03
|
| Rate for Payer: The Alliance Commercial |
$48.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.03
|
| Rate for Payer: United Healthcare PPO |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: Wellcare Medicare |
$12.03
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
Lactic Acid
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
633772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$187.72 |
| Rate for Payer: Aetna Commercial |
$187.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.03
|
| Rate for Payer: Anthem Medicare Advantage |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.03
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$187.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.03
|
| Rate for Payer: Health EOS Commercial |
$179.82
|
| Rate for Payer: HFN Commercial |
$187.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.03
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$18.05
|
| Rate for Payer: Preferred Network Access Commercial |
$187.72
|
| Rate for Payer: Quartz Beloit One Network |
$86.94
|
| Rate for Payer: Quartz Commercial |
$112.63
|
| Rate for Payer: Quartz Medicare Advantage |
$12.03
|
| Rate for Payer: The Alliance Commercial |
$47.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.03
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$52.94
|
|
|
Lactic Acid
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
633772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
Lactoferrin Quant Stool
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
4520608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$20.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.89
|
| Rate for Payer: Anthem Medicare Advantage |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.42
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.42
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$30.62
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$20.42
|
| Rate for Payer: The Alliance Commercial |
$81.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.42
|
| Rate for Payer: United Healthcare PPO |
$276.90
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: Wellcare Medicare |
$20.42
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
Lactoferrin Quant Stool
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
4520608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$350.74 |
| Rate for Payer: Aetna Commercial |
$350.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$20.42
|
| Rate for Payer: Anthem Medicare Advantage |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.42
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$350.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.42
|
| Rate for Payer: Health EOS Commercial |
$335.97
|
| Rate for Payer: HFN Commercial |
$350.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$30.62
|
| Rate for Payer: Preferred Network Access Commercial |
$350.74
|
| Rate for Payer: Quartz Beloit One Network |
$162.45
|
| Rate for Payer: Quartz Commercial |
$210.44
|
| Rate for Payer: Quartz Medicare Advantage |
$20.42
|
| Rate for Payer: The Alliance Commercial |
$80.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.42
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$89.83
|
|
|
Lactoferrin Quant Stool
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
4520608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
LAFORTE OSTEOTOMY
|
Facility
|
OP
|
$6,808.00
|
|
| Hospital Charge Code |
2960171
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.49 |
| Max. Negotiated Rate |
$6,513.89 |
| Rate for Payer: Aetna Commercial |
$6,372.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,089.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,982.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,602.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,540.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,398.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,752.57
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,513.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,962.26
|
| Rate for Payer: Health EOS Commercial |
$6,301.48
|
| Rate for Payer: HFN Commercial |
$6,513.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,310.24
|
| Rate for Payer: Multiplan Commercial |
$5,664.26
|
| Rate for Payer: NAPHCARE Commercial |
$4,248.19
|
| Rate for Payer: Preferred Network Access Commercial |
$6,513.89
|
| Rate for Payer: Quartz Beloit One Network |
$3,469.36
|
| Rate for Payer: Quartz Commercial |
$4,602.21
|
| Rate for Payer: Quartz Medicare Advantage |
$4,248.19
|
| Rate for Payer: The Alliance Commercial |
$3,540.16
|
| Rate for Payer: WEA Trust Commercial |
$3,894.18
|
| Rate for Payer: WPS Commercial |
$5,244.20
|
|
|
LAFORTE OSTEOTOMY
|
Facility
|
IP
|
$6,808.00
|
|
| Hospital Charge Code |
2960171
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,469.36 |
| Max. Negotiated Rate |
$6,513.89 |
| Rate for Payer: Aetna Commercial |
$6,372.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,089.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,752.57
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,513.89
|
| Rate for Payer: Health EOS Commercial |
$6,301.48
|
| Rate for Payer: HFN Commercial |
$6,513.89
|
| Rate for Payer: Multiplan Commercial |
$5,664.26
|
| Rate for Payer: Preferred Network Access Commercial |
$6,513.89
|
| Rate for Payer: Quartz Beloit One Network |
$3,469.36
|
| Rate for Payer: Quartz Commercial |
$4,248.19
|
| Rate for Payer: WEA Trust Commercial |
$3,894.18
|
| Rate for Payer: WPS Commercial |
$5,244.20
|
|
|
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 |
$1,594.03 |
| 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
|
|
|
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 |
$2,789.55 |
| 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
|
|
|
LAG SCREW 10.5X75MM TI 3060-0075S
|
Facility
|
OP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4518614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.72 |
| Max. Negotiated Rate |
$4,237.67 |
| Rate for Payer: Aetna Commercial |
$4,145.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,961.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,289.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,994.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,303.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,210.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,441.26
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,237.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,577.68
|
| Rate for Payer: Health EOS Commercial |
$4,099.48
|
| Rate for Payer: HFN Commercial |
$4,237.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,454.62
|
| Rate for Payer: Multiplan Commercial |
$3,684.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,763.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,237.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.02
|
| Rate for Payer: Quartz Commercial |
$2,994.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,763.70
|
| Rate for Payer: The Alliance Commercial |
$2,303.08
|
| Rate for Payer: WEA Trust Commercial |
$2,533.39
|
| Rate for Payer: WPS Commercial |
$3,411.66
|
|
|
LAG SCREW 10.5X75MM TI 3060-0075S
|
Facility
|
IP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4518614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,257.02 |
| Max. Negotiated Rate |
$4,237.67 |
| Rate for Payer: Aetna Commercial |
$4,145.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,961.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,441.26
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,237.67
|
| Rate for Payer: Health EOS Commercial |
$4,099.48
|
| Rate for Payer: HFN Commercial |
$4,237.67
|
| Rate for Payer: Multiplan Commercial |
$3,684.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,237.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.02
|
| Rate for Payer: Quartz Commercial |
$2,763.70
|
| Rate for Payer: WEA Trust Commercial |
$2,533.39
|
| Rate for Payer: WPS Commercial |
$3,411.66
|
|
|
LAG SCREW 110MM OMEGA 3362-5-110
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Aetna Managed Medicare |
$738.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.95
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.08
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,714.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.46
|
| Rate for Payer: The Alliance Commercial |
$1,318.72
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
LAG SCREW 110MM OMEGA 3362-5-110
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.35 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,582.46
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
LAG SCREW 120MM TFNA FENESTRATED 04.038.220S
|
Facility
|
IP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5517290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.01 |
| Max. Negotiated Rate |
$5,033.72 |
| Rate for Payer: Aetna Commercial |
$4,924.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,705.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,899.86
|
| Rate for Payer: Cash Price |
$1,578.30
|
| Rate for Payer: Cigna Commercial |
$5,033.72
|
| Rate for Payer: Health EOS Commercial |
$4,869.58
|
| Rate for Payer: HFN Commercial |
$5,033.72
|
| Rate for Payer: Multiplan Commercial |
$4,377.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.01
|
| Rate for Payer: Quartz Commercial |
$3,282.86
|
| Rate for Payer: WEA Trust Commercial |
$3,009.29
|
| Rate for Payer: WPS Commercial |
$4,052.55
|
|
|
LAG SCREW 120MM TFNA FENESTRATED 04.038.220S
|
Facility
|
OP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5517290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.00 |
| Max. Negotiated Rate |
$5,033.72 |
| Rate for Payer: Aetna Commercial |
$4,924.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,705.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,556.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,735.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,626.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,899.86
|
| Rate for Payer: Cash Price |
$1,578.30
|
| Rate for Payer: Cigna Commercial |
$5,033.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,061.90
|
| Rate for Payer: Health EOS Commercial |
$4,869.58
|
| Rate for Payer: HFN Commercial |
$5,033.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,103.58
|
| Rate for Payer: Multiplan Commercial |
$4,377.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,282.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.01
|
| Rate for Payer: Quartz Commercial |
$3,556.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,282.86
|
| Rate for Payer: The Alliance Commercial |
$2,735.72
|
| Rate for Payer: WEA Trust Commercial |
$3,009.29
|
| Rate for Payer: WPS Commercial |
$4,052.55
|
|
|
LAG SCREW 3.5 X 22 ORTHOLOC 3Di CROSSCHECK 5820X3522
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.03 |
| Max. Negotiated Rate |
$3,095.25 |
| Rate for Payer: Aetna Commercial |
$3,027.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,893.38
|
| Rate for Payer: Aetna Managed Medicare |
$942.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,186.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,682.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,614.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,783.13
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$3,095.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,882.77
|
| Rate for Payer: Health EOS Commercial |
$2,994.32
|
| Rate for Payer: HFN Commercial |
$3,095.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,523.30
|
| Rate for Payer: Multiplan Commercial |
$2,691.52
|
| Rate for Payer: NAPHCARE Commercial |
$2,018.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,095.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.56
|
| Rate for Payer: Quartz Commercial |
$2,186.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,018.64
|
| Rate for Payer: The Alliance Commercial |
$1,682.20
|
| Rate for Payer: WEA Trust Commercial |
$1,850.42
|
| Rate for Payer: WPS Commercial |
$2,491.92
|
|
|
LAG SCREW 3.5 X 22 ORTHOLOC 3Di CROSSCHECK 5820X3522
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.56 |
| Max. Negotiated Rate |
$3,095.25 |
| Rate for Payer: Aetna Commercial |
$3,027.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,893.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,783.13
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$3,095.25
|
| Rate for Payer: Health EOS Commercial |
$2,994.32
|
| Rate for Payer: HFN Commercial |
$3,095.25
|
| Rate for Payer: Multiplan Commercial |
$2,691.52
|
| Rate for Payer: Preferred Network Access Commercial |
$3,095.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.56
|
| Rate for Payer: Quartz Commercial |
$2,018.64
|
| Rate for Payer: WEA Trust Commercial |
$1,850.42
|
| Rate for Payer: WPS Commercial |
$2,491.92
|
|
