|
Ova & Parasite, Quest Confirmation
|
Facility
|
OP
|
$13.30
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
983349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$37.02 |
| Rate for Payer: Aetna Commercial |
$12.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11.90
|
| Rate for Payer: Aetna Managed Medicare |
$9.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Anthem Medicare Advantage |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.26
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cigna Commercial |
$12.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.26
|
| Rate for Payer: Health EOS Commercial |
$12.31
|
| Rate for Payer: HFN Commercial |
$12.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.26
|
| Rate for Payer: Multiplan Commercial |
$11.07
|
| Rate for Payer: NAPHCARE Commercial |
$13.88
|
| Rate for Payer: Preferred Network Access Commercial |
$12.73
|
| Rate for Payer: Quartz Beloit One Network |
$6.78
|
| Rate for Payer: Quartz Commercial |
$8.99
|
| Rate for Payer: Quartz Medicare Advantage |
$9.26
|
| Rate for Payer: The Alliance Commercial |
$37.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.26
|
| Rate for Payer: United Healthcare PPO |
$10.37
|
| Rate for Payer: WEA Trust Commercial |
$7.61
|
| Rate for Payer: Wellcare Medicare |
$9.26
|
| Rate for Payer: WPS Commercial |
$10.24
|
|
|
Ova & Parasite, Quest Confirmation
|
Professional
|
Both
|
$13.30
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
983349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Aetna Commercial |
$13.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11.90
|
| Rate for Payer: Aetna Managed Medicare |
$9.26
|
| Rate for Payer: Anthem Medicare Advantage |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.26
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cigna Commercial |
$13.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.26
|
| Rate for Payer: Health EOS Commercial |
$12.59
|
| Rate for Payer: HFN Commercial |
$13.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.26
|
| Rate for Payer: Multiplan Commercial |
$11.07
|
| Rate for Payer: NAPHCARE Commercial |
$13.88
|
| Rate for Payer: Preferred Network Access Commercial |
$13.14
|
| Rate for Payer: Quartz Beloit One Network |
$6.09
|
| Rate for Payer: Quartz Commercial |
$7.88
|
| Rate for Payer: Quartz Medicare Advantage |
$9.26
|
| Rate for Payer: The Alliance Commercial |
$36.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.26
|
| Rate for Payer: WEA Trust Commercial |
$7.61
|
| Rate for Payer: WPS Commercial |
$40.73
|
|
|
Ova & Parasite, Quest Confirmation
|
Facility
|
IP
|
$13.30
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
983349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$12.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7.33
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cigna Commercial |
$12.73
|
| Rate for Payer: Health EOS Commercial |
$12.31
|
| Rate for Payer: HFN Commercial |
$12.73
|
| Rate for Payer: Multiplan Commercial |
$11.07
|
| Rate for Payer: Preferred Network Access Commercial |
$12.73
|
| Rate for Payer: Quartz Beloit One Network |
$6.78
|
| Rate for Payer: Quartz Commercial |
$8.30
|
| Rate for Payer: WEA Trust Commercial |
$7.61
|
| Rate for Payer: WPS Commercial |
$10.24
|
|
|
OVARIAN CYSTECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
OVARIAN CYSTECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 58925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
OVERDRILL 2.7MM X 122MM AO STRYKER 703897
|
Facility
|
IP
|
$1,346.00
|
|
| Hospital Charge Code |
5685725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.92 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$839.90
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
OVERDRILL 2.7MM X 122MM AO STRYKER 703897
|
Facility
|
OP
|
$1,346.00
|
|
| Hospital Charge Code |
5685725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.96 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Aetna Managed Medicare |
$391.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.37
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.88
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: NAPHCARE Commercial |
$839.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$909.90
|
| Rate for Payer: Quartz Medicare Advantage |
$839.90
|
| Rate for Payer: The Alliance Commercial |
$699.92
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
OVERDRILL 2.7 X 122MM 703695
|
Facility
|
IP
|
$1,294.00
|
|
| Hospital Charge Code |
6151690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.42 |
| Max. Negotiated Rate |
$1,238.10 |
| Rate for Payer: Aetna Commercial |
$1,211.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.25
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,238.10
|
| Rate for Payer: Health EOS Commercial |
$1,197.73
|
| Rate for Payer: HFN Commercial |
$1,238.10
|
| Rate for Payer: Multiplan Commercial |
$1,076.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.10
|
| Rate for Payer: Quartz Beloit One Network |
$659.42
|
| Rate for Payer: Quartz Commercial |
$807.46
|
| Rate for Payer: WEA Trust Commercial |
$740.17
|
| Rate for Payer: WPS Commercial |
$996.77
|
|
|
OVERDRILL 2.7 X 122MM 703695
|
Facility
|
OP
|
$1,294.00
|
|
| Hospital Charge Code |
6151690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.81 |
| Max. Negotiated Rate |
$1,238.10 |
| Rate for Payer: Aetna Commercial |
$1,211.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.35
|
| Rate for Payer: Aetna Managed Medicare |
$376.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$672.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$645.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.25
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,238.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.11
|
| Rate for Payer: Health EOS Commercial |
$1,197.73
|
| Rate for Payer: HFN Commercial |
$1,238.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,009.32
|
| Rate for Payer: Multiplan Commercial |
$1,076.61
|
| Rate for Payer: NAPHCARE Commercial |
$807.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.10
|
| Rate for Payer: Quartz Beloit One Network |
$659.42
|
| Rate for Payer: Quartz Commercial |
$874.74
|
| Rate for Payer: Quartz Medicare Advantage |
$807.46
|
| Rate for Payer: The Alliance Commercial |
$672.88
|
| Rate for Payer: WEA Trust Commercial |
$740.17
|
| Rate for Payer: WPS Commercial |
$996.77
|
|
|
OVERDRILL 3.5 X 122MM 703694
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
5599691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
OVERDRILL 3.5 X 122MM 703694
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
5599691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$407.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$946.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.80
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$873.60
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
OVERDRILL QUIX 2-IN-1 159027SND
|
Facility
|
IP
|
$2,321.00
|
|
| Hospital Charge Code |
5627646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,182.78 |
| Max. Negotiated Rate |
$2,220.73 |
| Rate for Payer: Aetna Commercial |
$2,172.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.34
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,220.73
|
| Rate for Payer: Health EOS Commercial |
$2,148.32
|
| Rate for Payer: HFN Commercial |
$2,220.73
|
| Rate for Payer: Multiplan Commercial |
$1,931.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.78
|
| Rate for Payer: Quartz Commercial |
$1,448.30
|
| Rate for Payer: WEA Trust Commercial |
$1,327.61
|
| Rate for Payer: WPS Commercial |
$1,787.87
|
|
|
OVERDRILL QUIX 2-IN-1 159027SND
|
Facility
|
OP
|
$2,321.00
|
|
| Hospital Charge Code |
5627646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.88 |
| Max. Negotiated Rate |
$2,220.73 |
| Rate for Payer: Aetna Commercial |
$2,172.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.90
|
| Rate for Payer: Aetna Managed Medicare |
$675.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,569.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,158.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.34
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,220.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.82
|
| Rate for Payer: Health EOS Commercial |
$2,148.32
|
| Rate for Payer: HFN Commercial |
$2,220.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,810.38
|
| Rate for Payer: Multiplan Commercial |
$1,931.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,448.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.78
|
| Rate for Payer: Quartz Commercial |
$1,569.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,448.30
|
| Rate for Payer: The Alliance Commercial |
$1,206.92
|
| Rate for Payer: WEA Trust Commercial |
$1,327.61
|
| Rate for Payer: WPS Commercial |
$1,787.87
|
|
|
Oxacillin Level, Bioassay
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Oxacillin Level, Bioassay
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$287.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$287.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$275.40
|
| Rate for Payer: HFN Commercial |
$287.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$287.51
|
| Rate for Payer: Quartz Beloit One Network |
$133.16
|
| Rate for Payer: Quartz Commercial |
$172.50
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Oxacillin Level, Bioassay
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$226.98
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Oxalate, Urine
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
5474693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Oxalate, Urine
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
5474693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$3.72
|
| Rate for Payer: Anthem Medicare Advantage |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.72
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$5.58
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$3.72
|
| Rate for Payer: The Alliance Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.72
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$16.38
|
|
|
Oxalate, Urine
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
5474693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$3.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.18
|
| Rate for Payer: Anthem Medicare Advantage |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.72
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$5.58
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$3.72
|
| Rate for Payer: The Alliance Commercial |
$14.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.72
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$3.72
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
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 |
$15.03 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
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 |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
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 |
$15.03 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$60.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Oxcarbazepine (Trileptal) Level
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$71.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.32
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$152.26
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$152.26
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: United Healthcare PPO |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Oxcarbazepine (Trileptal) Level
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.26
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
