|
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
|
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 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 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
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
|
