|
LUMPECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LUMPECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LUMPECTOMY, BREAST W/ ULTRASOUND GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LUMPECTOMY, BREAST W/ ULTRASOUND GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LUMPECTOMY, BREAST W/ X-RAY NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2556799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LUMPECTOMY, BREAST W/ X-RAY NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2556799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$326,434.00
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$117,422.46 |
| Max. Negotiated Rate |
$326,434.00 |
| Rate for Payer: Aetna Managed Medicare |
$117,422.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257,424.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$197,313.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187,461.06
|
| Rate for Payer: Anthem Medicare Advantage |
$117,422.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117,422.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117,422.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$117,422.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208,098.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$117,422.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239,194.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117,422.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117,422.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$117,422.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$117,422.46
|
| Rate for Payer: NAPHCARE Commercial |
$176,133.69
|
| Rate for Payer: Quartz Medicare Advantage |
$117,422.46
|
| Rate for Payer: The Alliance Commercial |
$326,434.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117,422.46
|
| Rate for Payer: Wellcare Medicare |
$117,422.46
|
|
|
Lupron Depo 7.5 mg Charge
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
2958923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.00
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
Lupron Depo 7.5 mg Charge
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
2958923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$464.16 |
| Rate for Payer: Aetna Commercial |
$356.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$356.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$341.25
|
| Rate for Payer: HFN Commercial |
$356.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.94
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Preferred Network Access Commercial |
$356.25
|
| Rate for Payer: Quartz Beloit One Network |
$165.00
|
| Rate for Payer: Quartz Commercial |
$213.75
|
| Rate for Payer: The Alliance Commercial |
$187.50
|
| Rate for Payer: United Healthcare Medicaid |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Lupron Depo 7.5 mg Charge
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
2958923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$725.21 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Aetna Managed Medicare |
$181.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$243.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.00
|
| Rate for Payer: Anthem Medicare Advantage |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.30
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.30
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$271.95
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$243.75
|
| Rate for Payer: Quartz Medicare Advantage |
$181.30
|
| Rate for Payer: The Alliance Commercial |
$725.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: Wellcare Medicare |
$181.30
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Lupus Anticoagulant Evaluation w/ Reflex
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.00
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: HFN Commercial |
$71.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$71.25
|
| Rate for Payer: Quartz Beloit One Network |
$33.00
|
| Rate for Payer: Quartz Commercial |
$42.75
|
| Rate for Payer: The Alliance Commercial |
$37.50
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Lupus Anticoagulant Evaluation w/ Reflex
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicaid |
$6.21
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Dean Health Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.21
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$56.25
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WMAP Medicaid |
$6.21
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Lupus Anticoagulant Evaluation w/ Reflex
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
LURIA NEBRASKA BATTERY
|
Facility
|
IP
|
$1,089.00
|
|
| Hospital Charge Code |
2972007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$533.61 |
| Max. Negotiated Rate |
$1,001.88 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.17
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna Commercial |
$1,001.88
|
| Rate for Payer: Health EOS Commercial |
$969.21
|
| Rate for Payer: HFN Commercial |
$1,001.88
|
| Rate for Payer: Multiplan Commercial |
$871.20
|
| Rate for Payer: NAPHCARE Commercial |
$653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,001.88
|
| Rate for Payer: Quartz Beloit One Network |
$533.61
|
| Rate for Payer: Quartz Commercial |
$653.40
|
| Rate for Payer: WEA Trust Commercial |
$598.95
|
| Rate for Payer: WPS Commercial |
$806.62
|
|
|
LURIA NEBRASKA BATTERY
|
Facility
|
OP
|
$1,089.00
|
|
| Hospital Charge Code |
2972007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$4,356.00 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.54
|
| Rate for Payer: Aetna Managed Medicare |
$304.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$707.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$522.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.17
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna Commercial |
$1,001.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$609.40
|
| Rate for Payer: Health EOS Commercial |
$969.21
|
| Rate for Payer: HFN Commercial |
$1,001.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.75
|
| Rate for Payer: Multiplan Commercial |
$871.20
|
| Rate for Payer: NAPHCARE Commercial |
$653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,001.88
|
| Rate for Payer: Quartz Beloit One Network |
$533.61
|
| Rate for Payer: Quartz Commercial |
$707.85
|
| Rate for Payer: Quartz Medicare Advantage |
$653.40
|
| Rate for Payer: The Alliance Commercial |
$4,356.00
|
| Rate for Payer: WEA Trust Commercial |
$598.95
|
| Rate for Payer: WPS Commercial |
$806.62
|
|
|
Luteinizing Hormone Level
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
633779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.38 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna Commercial |
$330.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$330.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.80
|
| Rate for Payer: Health EOS Commercial |
$316.68
|
| Rate for Payer: HFN Commercial |
$330.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.38
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.60
|
| Rate for Payer: Quartz Beloit One Network |
$153.12
|
| Rate for Payer: Quartz Commercial |
$198.36
|
| Rate for Payer: The Alliance Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Luteinizing Hormone Level
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
633779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$18.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.74
|
| Rate for Payer: Anthem Medicaid |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$18.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.52
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.74
|
| Rate for Payer: Dean Health Medicaid |
$19.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.52
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.52
|
| Rate for Payer: Managed Health Services Medicaid |
$19.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.78
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$18.52
|
| Rate for Payer: The Alliance Commercial |
$74.08
|
| Rate for Payer: United Healthcare Medicaid |
$19.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare PPO |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: Wellcare Medicare |
$18.52
|
| Rate for Payer: WMAP Medicaid |
$19.14
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Luteinizing Hormone Level
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
633779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3315648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.80
|
| Rate for Payer: Health EOS Commercial |
$116.48
|
| Rate for Payer: HFN Commercial |
$121.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.12
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$121.60
|
| Rate for Payer: Quartz Beloit One Network |
$56.32
|
| Rate for Payer: Quartz Commercial |
$72.96
|
| Rate for Payer: The Alliance Commercial |
$64.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3315648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3315648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$17.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$17.60
|
| Rate for Payer: Anthem Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.03
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Dean Health Medicaid |
$17.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.03
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.03
|
| Rate for Payer: Managed Health Services Medicaid |
$18.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.54
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.60
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$17.03
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicaid |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare PPO |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: WMAP Medicaid |
$17.60
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3331547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3331547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.80
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: HFN Commercial |
$93.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.12
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: The Alliance Commercial |
$49.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Lyme Disease Antibodies (IgG, IgM) CSF
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
3331547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$17.60
|
| Rate for Payer: Anthem Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.03
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Dean Health Medicaid |
$17.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.03
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.03
|
| Rate for Payer: Managed Health Services Medicaid |
$18.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.54
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.60
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$17.03
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicaid |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: WMAP Medicaid |
$17.60
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Lyme Disease Antibodies (IgG, IgM) Western Blot
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3256235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$206.08 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$134.40
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
