|
Ova & Parasite, Quest Confirmation
|
Professional
|
Both
|
$13.30
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
983349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.42 |
| Rate for Payer: Aetna Commercial |
$12.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11.44
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.98
|
| Rate for Payer: Health EOS Commercial |
$12.10
|
| Rate for Payer: HFN Commercial |
$12.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.42
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Preferred Network Access Commercial |
$12.64
|
| Rate for Payer: Quartz Beloit One Network |
$5.85
|
| Rate for Payer: Quartz Commercial |
$7.58
|
| Rate for Payer: The Alliance Commercial |
$6.65
|
| Rate for Payer: WEA Trust Commercial |
$7.32
|
| Rate for Payer: WPS Commercial |
$9.85
|
|
|
OVARIAN CYSTECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
OVARIAN CYSTECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
|
Facility
|
OP
|
$19,665.00
|
|
|
Service Code
|
CPT 58925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$19,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$19,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
OVERDRILL 2.7MM X 122MM AO STRYKER 703897
|
Facility
|
IP
|
$1,346.00
|
|
| Hospital Charge Code |
5685725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.54 |
| Max. Negotiated Rate |
$1,238.32 |
| Rate for Payer: Aetna Commercial |
$1,211.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.38
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,238.32
|
| Rate for Payer: Health EOS Commercial |
$1,197.94
|
| Rate for Payer: HFN Commercial |
$1,238.32
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$807.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.32
|
| Rate for Payer: Quartz Beloit One Network |
$659.54
|
| Rate for Payer: Quartz Commercial |
$807.60
|
| Rate for Payer: WEA Trust Commercial |
$740.30
|
| Rate for Payer: WPS Commercial |
$996.98
|
|
|
OVERDRILL 2.7MM X 122MM AO STRYKER 703897
|
Facility
|
OP
|
$1,346.00
|
|
| Hospital Charge Code |
5685725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.88 |
| Max. Negotiated Rate |
$5,384.00 |
| Rate for Payer: Aetna Commercial |
$1,211.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.56
|
| Rate for Payer: Aetna Managed Medicare |
$376.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.38
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,238.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.22
|
| Rate for Payer: Health EOS Commercial |
$1,197.94
|
| Rate for Payer: HFN Commercial |
$1,238.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,009.50
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$807.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.32
|
| Rate for Payer: Quartz Beloit One Network |
$659.54
|
| Rate for Payer: Quartz Commercial |
$874.90
|
| Rate for Payer: Quartz Medicare Advantage |
$807.60
|
| Rate for Payer: The Alliance Commercial |
$5,384.00
|
| Rate for Payer: WEA Trust Commercial |
$740.30
|
| Rate for Payer: WPS Commercial |
$996.98
|
|
|
OVERDRILL 2.7 X 122MM 703695
|
Facility
|
IP
|
$1,294.00
|
|
| Hospital Charge Code |
6151690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$634.06 |
| Max. Negotiated Rate |
$1,190.48 |
| Rate for Payer: Aetna Commercial |
$1,164.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.82
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,190.48
|
| Rate for Payer: Health EOS Commercial |
$1,151.66
|
| Rate for Payer: HFN Commercial |
$1,190.48
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$776.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.48
|
| Rate for Payer: Quartz Beloit One Network |
$634.06
|
| Rate for Payer: Quartz Commercial |
$776.40
|
| Rate for Payer: WEA Trust Commercial |
$711.70
|
| Rate for Payer: WPS Commercial |
$958.47
|
|
|
OVERDRILL 2.7 X 122MM 703695
|
Facility
|
OP
|
$1,294.00
|
|
| Hospital Charge Code |
6151690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.32 |
| Max. Negotiated Rate |
$5,176.00 |
| Rate for Payer: Aetna Commercial |
$1,164.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.84
|
| Rate for Payer: Aetna Managed Medicare |
$362.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$841.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$647.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.82
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,190.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.12
|
| Rate for Payer: Health EOS Commercial |
$1,151.66
|
| Rate for Payer: HFN Commercial |
$1,190.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.50
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$776.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.48
|
| Rate for Payer: Quartz Beloit One Network |
$634.06
|
| Rate for Payer: Quartz Commercial |
$841.10
|
| Rate for Payer: Quartz Medicare Advantage |
$776.40
|
| Rate for Payer: The Alliance Commercial |
$5,176.00
|
| Rate for Payer: WEA Trust Commercial |
$711.70
|
| Rate for Payer: WPS Commercial |
$958.47
|
|
|
OVERDRILL 3.5 X 122MM 703694
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
5599691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
OVERDRILL 3.5 X 122MM 703694
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
5599691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Aetna Managed Medicare |
$392.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.44
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$910.00
|
| Rate for Payer: Quartz Medicare Advantage |
$840.00
|
| Rate for Payer: The Alliance Commercial |
$5,600.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
OVERDRILL QUIX 2-IN-1 159027SND
|
Facility
|
OP
|
$2,321.00
|
|
| Hospital Charge Code |
5627646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.88 |
| Max. Negotiated Rate |
$9,284.00 |
| Rate for Payer: Aetna Commercial |
$2,088.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.06
|
| Rate for Payer: Aetna Managed Medicare |
$649.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,114.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.13
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,135.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,298.83
|
| Rate for Payer: Health EOS Commercial |
$2,065.69
|
| Rate for Payer: HFN Commercial |
$2,135.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.75
|
| Rate for Payer: Multiplan Commercial |
$1,856.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.29
|
| Rate for Payer: Quartz Commercial |
$1,508.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.60
|
| Rate for Payer: The Alliance Commercial |
$9,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.55
|
| Rate for Payer: WPS Commercial |
$1,719.16
|
|
|
OVERDRILL QUIX 2-IN-1 159027SND
|
Facility
|
IP
|
$2,321.00
|
|
| Hospital Charge Code |
5627646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,137.29 |
| Max. Negotiated Rate |
$2,135.32 |
| Rate for Payer: Aetna Commercial |
$2,088.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.13
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,135.32
|
| Rate for Payer: Health EOS Commercial |
$2,065.69
|
| Rate for Payer: HFN Commercial |
$2,135.32
|
| Rate for Payer: Multiplan Commercial |
$1,856.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.29
|
| Rate for Payer: Quartz Commercial |
$1,392.60
|
| Rate for Payer: WEA Trust Commercial |
$1,276.55
|
| Rate for Payer: WPS Commercial |
$1,719.16
|
|
|
Oxacillin Level, Bioassay
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.84
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$189.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$218.25
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
Oxacillin Level, Bioassay
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$174.60
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
Oxacillin Level, Bioassay
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Aetna Commercial |
$276.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$276.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Health EOS Commercial |
$264.81
|
| Rate for Payer: HFN Commercial |
$276.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$276.45
|
| Rate for Payer: Quartz Beloit One Network |
$128.04
|
| Rate for Payer: Quartz Commercial |
$165.87
|
| Rate for Payer: The Alliance Commercial |
$145.50
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
Oxalate, Urine
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
5474693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.94
|
| Rate for Payer: Anthem Medicaid |
$3.70
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| Rate for Payer: Managed Health Services Medicaid |
$3.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$5.37
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.70
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$14.32
|
| Rate for Payer: United Healthcare Medicaid |
$3.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: WMAP Medicaid |
$3.70
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Oxalate, Urine
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
5474693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.80
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.64
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Oxalate, Urine
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
5474693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Oxalic Acid, 24 Hr Urine w/ Creatinine
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
983352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.20
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: HFN Commercial |
$130.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.01
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: The Alliance Commercial |
$68.50
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Oxalic Acid, 24 Hr Urine w/ Creatinine
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
983352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$14.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.99
|
| Rate for Payer: Anthem Medicaid |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.45
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Dean Health Medicaid |
$14.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.45
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.45
|
| Rate for Payer: Managed Health Services Medicaid |
$15.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$21.68
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.93
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.45
|
| Rate for Payer: The Alliance Commercial |
$57.80
|
| Rate for Payer: United Healthcare Medicaid |
$14.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$14.45
|
| Rate for Payer: WMAP Medicaid |
$14.93
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Oxalic Acid, 24 Hr Urine w/ Creatinine
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
983352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Oxcarbazepine (Trileptal) Level
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Oxcarbazepine (Trileptal) Level
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna Commercial |
$231.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$231.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.40
|
| Rate for Payer: Health EOS Commercial |
$222.04
|
| Rate for Payer: HFN Commercial |
$231.80
|
| 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 |
$195.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.80
|
| Rate for Payer: Quartz Beloit One Network |
$107.36
|
| Rate for Payer: Quartz Commercial |
$139.08
|
| Rate for Payer: The Alliance Commercial |
$122.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Oxcarbazepine (Trileptal) Level
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$976.00 |
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| Rate for Payer: Quartz Medicare Advantage |
$146.40
|
| Rate for Payer: The Alliance Commercial |
$976.00
|
| Rate for Payer: United Healthcare PPO |
$183.00
|
|
|
Oxepa
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
