|
LAG SCREW TFNA 85MM 04.038.185S
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5583217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.41 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.53
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| Rate for Payer: Multiplan Commercial |
$642.30
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$481.73
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
|
LAG SCREW TFNA 90MM 04.038.090S
|
Facility
|
OP
|
$5,684.00
|
|
| Hospital Charge Code |
4641032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.18 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,655.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,842.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,955.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,837.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,308.09
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,433.52
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,842.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.82
|
| Rate for Payer: The Alliance Commercial |
$2,955.68
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
LAG SCREW TFNA 90MM 04.038.090S
|
Facility
|
IP
|
$5,684.00
|
|
| Hospital Charge Code |
4641032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,896.57 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,546.82
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
LAG SCREW TFNA 90MM 04.038.190S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520670
|
|
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 TFNA 90MM 04.038.190S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520670
|
|
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 TFNA 95MM 04.038.095S
|
Facility
|
IP
|
$6,267.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,193.66 |
| Max. Negotiated Rate |
$5,996.27 |
| Rate for Payer: Aetna Commercial |
$5,865.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.37
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,996.27
|
| Rate for Payer: Health EOS Commercial |
$5,800.74
|
| Rate for Payer: HFN Commercial |
$5,996.27
|
| Rate for Payer: Multiplan Commercial |
$5,214.14
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.66
|
| Rate for Payer: Quartz Commercial |
$3,910.61
|
| Rate for Payer: WEA Trust Commercial |
$3,584.72
|
| Rate for Payer: WPS Commercial |
$4,827.47
|
|
|
LAG SCREW TFNA 95MM 04.038.095S
|
Facility
|
OP
|
$6,267.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.95 |
| Max. Negotiated Rate |
$5,996.27 |
| Rate for Payer: Aetna Commercial |
$5,865.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,824.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,236.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,258.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,128.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.37
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,996.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,647.39
|
| Rate for Payer: Health EOS Commercial |
$5,800.74
|
| Rate for Payer: HFN Commercial |
$5,996.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,888.26
|
| Rate for Payer: Multiplan Commercial |
$5,214.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,910.61
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.66
|
| Rate for Payer: Quartz Commercial |
$4,236.49
|
| Rate for Payer: Quartz Medicare Advantage |
$3,910.61
|
| Rate for Payer: The Alliance Commercial |
$3,258.84
|
| Rate for Payer: WEA Trust Commercial |
$3,584.72
|
| Rate for Payer: WPS Commercial |
$4,827.47
|
|
|
LAG SCREW TFNA 95MM 04.038.195S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,789.55 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,415.78
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
LAG SCREW TFNA 95MM 04.038.195S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,594.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,700.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,846.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,732.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.87
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,269.72
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,415.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,700.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,415.78
|
| Rate for Payer: The Alliance Commercial |
$2,846.48
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
Lambda Light Chains Free
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$211.05
|
| Rate for Payer: HFN Commercial |
$220.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$220.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.04
|
| Rate for Payer: Quartz Commercial |
$132.19
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Lambda Light Chains Free
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$173.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Lambda Light Chains Free
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
LAMINECTOMY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
LAMINECTOMY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT, CERVICAL, THORACIC, OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,673.35
|
|
|
Service Code
|
CPT 63048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.14 |
| Max. Negotiated Rate |
$8,673.35 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: The Alliance Commercial |
$667.14
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; LUMBAR
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 63047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 63030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Lamotrigine Level
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Lamotrigine Level
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Lamotrigine Level
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED COLON RESECTION
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED COLON RESECTION
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
