|
Office/OutPatient Visit, New 99204DSC
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3301487
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.94 |
| Max. Negotiated Rate |
$457.42 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$292.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.80
|
| Rate for Payer: Health EOS Commercial |
$280.28
|
| Rate for Payer: HFN Commercial |
$292.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.42
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$292.60
|
| Rate for Payer: Quartz Beloit One Network |
$135.52
|
| Rate for Payer: Quartz Commercial |
$175.56
|
| Rate for Payer: The Alliance Commercial |
$154.00
|
| Rate for Payer: United Healthcare Medicaid |
$110.94
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
Office/OutPatient Visit, New 99205DSC
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
3301489
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.41 |
| Max. Negotiated Rate |
$621.10 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.60
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: HFN Commercial |
$376.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$621.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$621.10
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: The Alliance Commercial |
$198.00
|
| Rate for Payer: United Healthcare Medicaid |
$146.41
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
Office/OutPatient Visit Respiratory
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5252606
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Office/OutPatient Visit Respiratory
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5252606
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$47.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.13
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$110.50
|
| Rate for Payer: Quartz Medicare Advantage |
$102.00
|
| Rate for Payer: The Alliance Commercial |
$680.00
|
| Rate for Payer: United Healthcare PPO |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Office Visit New Pt Brief
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3040426
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Office Visit New Pt Brief
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3040426
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Office Visit New Pt Extended
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3040428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Office Visit New Pt Extended
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3040428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$1,768.00 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$123.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.34
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.50
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$265.20
|
| Rate for Payer: The Alliance Commercial |
$1,768.00
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Office Visit New Pt Routine
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
3040427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$97.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| 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: Dean Health DHI/DHP/ASO |
$194.74
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.00
|
| 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 |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$208.80
|
| Rate for Payer: The Alliance Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Office Visit New Pt Routine
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
3040427
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
OINTMENT ALOE VESTA PROTECTIVE 8 OZ 324908
|
Facility
|
OP
|
$853.00
|
|
| Hospital Charge Code |
4108270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.84 |
| Max. Negotiated Rate |
$3,412.00 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Aetna Managed Medicare |
$238.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$554.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.34
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$639.75
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$554.45
|
| Rate for Payer: Quartz Medicare Advantage |
$511.80
|
| Rate for Payer: The Alliance Commercial |
$3,412.00
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
OINTMENT ALOE VESTA PROTECTIVE 8 OZ 324908
|
Facility
|
IP
|
$853.00
|
|
| Hospital Charge Code |
4108270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.97 |
| Max. Negotiated Rate |
$784.76 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$511.80
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
OJ Autoabs
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
OJ Autoabs
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
OJ Autoabs
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Olanzapine
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$2,212.00 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Aetna Managed Medicare |
$154.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.09
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$508.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.46
|
| Rate for Payer: Health EOS Commercial |
$492.17
|
| Rate for Payer: HFN Commercial |
$508.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.75
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: NAPHCARE Commercial |
$331.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.76
|
| Rate for Payer: Quartz Beloit One Network |
$270.97
|
| Rate for Payer: Quartz Commercial |
$359.45
|
| Rate for Payer: Quartz Medicare Advantage |
$331.80
|
| Rate for Payer: The Alliance Commercial |
$2,212.00
|
| Rate for Payer: United Healthcare PPO |
$414.75
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
Olanzapine
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$525.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$525.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.80
|
| Rate for Payer: Health EOS Commercial |
$503.23
|
| Rate for Payer: HFN Commercial |
$525.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Preferred Network Access Commercial |
$525.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.32
|
| Rate for Payer: Quartz Commercial |
$315.21
|
| Rate for Payer: The Alliance Commercial |
$276.50
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
Olanzapine
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$270.97 |
| Max. Negotiated Rate |
$508.76 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.09
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$508.76
|
| Rate for Payer: Health EOS Commercial |
$492.17
|
| Rate for Payer: HFN Commercial |
$508.76
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: NAPHCARE Commercial |
$331.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.76
|
| Rate for Payer: Quartz Beloit One Network |
$270.97
|
| Rate for Payer: Quartz Commercial |
$331.80
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
OLECRANON BURSECTOMY
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2959883
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
OLECRANON BURSECTOMY
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959883
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
Oligoclonal Bands Cerebrospinal Fluid
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
978028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
Oligoclonal Bands Cerebrospinal Fluid
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
978028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.69 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$598.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.00
|
| Rate for Payer: Health EOS Commercial |
$573.30
|
| Rate for Payer: HFN Commercial |
$598.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.69
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.20
|
| Rate for Payer: Quartz Commercial |
$359.10
|
| Rate for Payer: The Alliance Commercial |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
Oligoclonal Bands Cerebrospinal Fluid
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
978028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Aetna Managed Medicare |
$27.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.47
|
| Rate for Payer: Anthem Medicaid |
$28.28
|
| Rate for Payer: Anthem Medicare Advantage |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.39
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.55
|
| Rate for Payer: Dean Health Medicaid |
$28.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.39
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.39
|
| Rate for Payer: Managed Health Services Medicaid |
$29.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.39
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$41.08
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.28
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$409.50
|
| Rate for Payer: Quartz Medicare Advantage |
$27.39
|
| Rate for Payer: The Alliance Commercial |
$109.56
|
| Rate for Payer: United Healthcare Medicaid |
$28.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.39
|
| Rate for Payer: United Healthcare PPO |
$472.50
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: Wellcare Medicare |
$27.39
|
| Rate for Payer: WMAP Medicaid |
$28.28
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
Oligoclonal Bands CSF
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
2958995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.69 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: HFN Commercial |
$371.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.69
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: The Alliance Commercial |
$195.50
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
Oligoclonal Bands CSF
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
2958995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$27.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.47
|
| Rate for Payer: Anthem Medicaid |
$28.28
|
| Rate for Payer: Anthem Medicare Advantage |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.39
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.80
|
| Rate for Payer: Dean Health Medicaid |
$28.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.39
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.39
|
| Rate for Payer: Managed Health Services Medicaid |
$29.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.39
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$41.08
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.28
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$27.39
|
| Rate for Payer: The Alliance Commercial |
$109.56
|
| Rate for Payer: United Healthcare Medicaid |
$28.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.39
|
| Rate for Payer: United Healthcare PPO |
$293.25
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$27.39
|
| Rate for Payer: WMAP Medicaid |
$28.28
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
