|
OPEN TX JAW FX W/INT FIXATION 21470
|
Professional
|
Both
|
$5,512.00
|
|
|
Service Code
|
CPT 21470
|
| Hospital Charge Code |
5605666
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,016.90 |
| Max. Negotiated Rate |
$5,236.40 |
| Rate for Payer: Aetna Commercial |
$5,236.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,740.32
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$5,236.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,016.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,307.20
|
| Rate for Payer: Health EOS Commercial |
$5,015.92
|
| Rate for Payer: HFN Commercial |
$5,236.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,897.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,897.26
|
| Rate for Payer: Multiplan Commercial |
$4,409.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,236.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,425.28
|
| Rate for Payer: Quartz Commercial |
$3,141.84
|
| Rate for Payer: The Alliance Commercial |
$2,756.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,016.90
|
| Rate for Payer: WEA Trust Commercial |
$3,031.60
|
| Rate for Payer: WPS Commercial |
$4,082.74
|
|
|
OPERATIVE KIT NANONEEDLE HIGH FLOW 125MM AR-3210-0051
|
Facility
|
IP
|
$1,308.57
|
|
| Hospital Charge Code |
6246226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.20 |
| Max. Negotiated Rate |
$1,203.88 |
| Rate for Payer: Aetna Commercial |
$1,177.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.54
|
| Rate for Payer: Cash Price |
$392.57
|
| Rate for Payer: Cigna Commercial |
$1,203.88
|
| Rate for Payer: Health EOS Commercial |
$1,164.63
|
| Rate for Payer: HFN Commercial |
$1,203.88
|
| Rate for Payer: Multiplan Commercial |
$1,046.86
|
| Rate for Payer: NAPHCARE Commercial |
$785.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.88
|
| Rate for Payer: Quartz Beloit One Network |
$641.20
|
| Rate for Payer: Quartz Commercial |
$785.14
|
| Rate for Payer: WEA Trust Commercial |
$719.71
|
| Rate for Payer: WPS Commercial |
$969.26
|
|
|
OPERATIVE KIT NANONEEDLE HIGH FLOW 125MM AR-3210-0051
|
Facility
|
OP
|
$1,308.57
|
|
| Hospital Charge Code |
6246226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$5,234.28 |
| Rate for Payer: Aetna Commercial |
$1,177.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.37
|
| Rate for Payer: Aetna Managed Medicare |
$366.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.54
|
| Rate for Payer: Cash Price |
$392.57
|
| Rate for Payer: Cigna Commercial |
$1,203.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.28
|
| Rate for Payer: Health EOS Commercial |
$1,164.63
|
| Rate for Payer: HFN Commercial |
$1,203.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.43
|
| Rate for Payer: Multiplan Commercial |
$1,046.86
|
| Rate for Payer: NAPHCARE Commercial |
$785.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.88
|
| Rate for Payer: Quartz Beloit One Network |
$641.20
|
| Rate for Payer: Quartz Commercial |
$850.57
|
| Rate for Payer: Quartz Medicare Advantage |
$785.14
|
| Rate for Payer: The Alliance Commercial |
$5,234.28
|
| Rate for Payer: WEA Trust Commercial |
$719.71
|
| Rate for Payer: WPS Commercial |
$969.26
|
|
|
OPERTV UPPER GI ENDOSCOPY, UNL VASC SURG 3779943255
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
6175019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,023.44 |
| Max. Negotiated Rate |
$2,209.70 |
| Rate for Payer: Aetna Commercial |
$2,209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,000.36
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cash Price |
$697.80
|
| Rate for Payer: Cigna Commercial |
$2,209.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,163.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,395.60
|
| Rate for Payer: Health EOS Commercial |
$2,116.66
|
| Rate for Payer: HFN Commercial |
$2,209.70
|
| Rate for Payer: Multiplan Commercial |
$1,860.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,023.44
|
| Rate for Payer: Quartz Commercial |
$1,325.82
|
| Rate for Payer: The Alliance Commercial |
$1,163.00
|
| Rate for Payer: WEA Trust Commercial |
$1,279.30
|
| Rate for Payer: WPS Commercial |
$1,722.87
|
|
|
Ophthalmic Biometry 92136
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
3560163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$186.74 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.74
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: United Healthcare Medicaid |
$74.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Ophthalmic Biometry 9213626
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 92136 26
|
| Hospital Charge Code |
3137577
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.16
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Ophthalmic Biometry, BILAT 9213650
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 92136 50
|
| Hospital Charge Code |
6170142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.32 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$335.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.80
|
| Rate for Payer: Health EOS Commercial |
$321.23
|
| Rate for Payer: HFN Commercial |
$335.35
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Preferred Network Access Commercial |
$335.35
|
| Rate for Payer: Quartz Beloit One Network |
$155.32
|
| Rate for Payer: Quartz Commercial |
$201.21
|
| Rate for Payer: The Alliance Commercial |
$176.50
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
OPHTHALMIC BURR REUSABLE 8550850
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
2969656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
OPHTHALMIC BURR REUSABLE 8550850
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
2969656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Aetna Managed Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.92
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$130.00
|
| Rate for Payer: Quartz Medicare Advantage |
$120.00
|
| Rate for Payer: The Alliance Commercial |
$800.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR 76510
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
CPT 76510
|
| Hospital Charge Code |
6187063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$223.08 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Aetna Commercial |
$481.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.02
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna Commercial |
$481.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.20
|
| Rate for Payer: Health EOS Commercial |
$461.37
|
| Rate for Payer: HFN Commercial |
$481.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$250.56
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$481.65
|
| Rate for Payer: Quartz Beloit One Network |
$223.08
|
| Rate for Payer: Quartz Commercial |
$288.99
|
| Rate for Payer: The Alliance Commercial |
$253.50
|
| Rate for Payer: WEA Trust Commercial |
$278.85
|
| Rate for Payer: WPS Commercial |
$375.53
|
|
|
OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR 7651026
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
CPT 76510 26
|
| Hospital Charge Code |
6187064
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$481.65 |
| Rate for Payer: Aetna Commercial |
$481.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.02
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna Commercial |
$481.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.20
|
| Rate for Payer: Health EOS Commercial |
$461.37
|
| Rate for Payer: HFN Commercial |
$481.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.47
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$481.65
|
| Rate for Payer: Quartz Beloit One Network |
$223.08
|
| Rate for Payer: Quartz Commercial |
$288.99
|
| Rate for Payer: The Alliance Commercial |
$253.50
|
| Rate for Payer: WEA Trust Commercial |
$278.85
|
| Rate for Payer: WPS Commercial |
$375.53
|
|
|
OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR, BILAT 7651050
|
Professional
|
Both
|
$1,014.00
|
|
|
Service Code
|
CPT 76510
|
| Hospital Charge Code |
6220020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Aetna Commercial |
$963.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.04
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cigna Commercial |
$963.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$507.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$608.40
|
| Rate for Payer: Health EOS Commercial |
$922.74
|
| Rate for Payer: HFN Commercial |
$963.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$250.56
|
| Rate for Payer: Multiplan Commercial |
$811.20
|
| Rate for Payer: Preferred Network Access Commercial |
$963.30
|
| Rate for Payer: Quartz Beloit One Network |
$446.16
|
| Rate for Payer: Quartz Commercial |
$577.98
|
| Rate for Payer: The Alliance Commercial |
$507.00
|
| Rate for Payer: WEA Trust Commercial |
$557.70
|
| Rate for Payer: WPS Commercial |
$751.07
|
|
|
Ophthalmological Services: Established Patient
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 92012
|
| Hospital Charge Code |
1122926
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$175.12 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.20
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: HFN Commercial |
$82.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.12
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicaid |
$29.99
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Ophthalmological Services: Established Patient Comprehensive
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 92014
|
| Hospital Charge Code |
1122927
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.54 |
| Max. Negotiated Rate |
$264.93 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.40
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: HFN Commercial |
$179.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.93
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: The Alliance Commercial |
$94.50
|
| Rate for Payer: United Healthcare Medicaid |
$44.54
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Ophthalmological Services: New Patient
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 92002
|
| Hospital Charge Code |
1122924
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$160.90 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.00
|
| Rate for Payer: Health EOS Commercial |
$109.20
|
| Rate for Payer: HFN Commercial |
$114.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.90
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$114.00
|
| Rate for Payer: Quartz Beloit One Network |
$52.80
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.97
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Ophthalmological Services: New Patient Comprehensive
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 92004
|
| Hospital Charge Code |
1122925
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$330.41 |
| Rate for Payer: Aetna Commercial |
$207.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$207.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.80
|
| Rate for Payer: Health EOS Commercial |
$198.38
|
| Rate for Payer: HFN Commercial |
$207.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$330.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$330.41
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$207.10
|
| Rate for Payer: Quartz Beloit One Network |
$95.92
|
| Rate for Payer: Quartz Commercial |
$124.26
|
| Rate for Payer: The Alliance Commercial |
$109.00
|
| Rate for Payer: United Healthcare Medicaid |
$44.33
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
OPHTHSCPY EXTND OPTC NRV/MACULA I&R UNI/BI 92202
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 92202
|
| Hospital Charge Code |
5561336
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$215.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.20
|
| Rate for Payer: Health EOS Commercial |
$206.57
|
| Rate for Payer: HFN Commercial |
$215.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.43
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$215.65
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$129.39
|
| Rate for Payer: The Alliance Commercial |
$113.50
|
| Rate for Payer: United Healthcare Medicaid |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
OPHTHSCPY EXTND RTA DRAW & SCL DEPRESN I&R UNI/BI 92201
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
CPT 92201
|
| Hospital Charge Code |
5561335
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Aetna Commercial |
$149.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$149.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.20
|
| Rate for Payer: Health EOS Commercial |
$142.87
|
| Rate for Payer: HFN Commercial |
$149.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.79
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Preferred Network Access Commercial |
$149.15
|
| Rate for Payer: Quartz Beloit One Network |
$69.08
|
| Rate for Payer: Quartz Commercial |
$89.49
|
| Rate for Payer: The Alliance Commercial |
$78.50
|
| Rate for Payer: United Healthcare Medicaid |
$19.56
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Opiates Confirmation Urine
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
983347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Opiates Confirmation Urine
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
983347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare PPO |
$275.25
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Opiates Confirmation Urine
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
983347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna Commercial |
$348.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$348.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.20
|
| Rate for Payer: Health EOS Commercial |
$333.97
|
| Rate for Payer: HFN Commercial |
$348.65
|
| 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 |
$293.60
|
| Rate for Payer: Preferred Network Access Commercial |
$348.65
|
| Rate for Payer: Quartz Beloit One Network |
$161.48
|
| Rate for Payer: Quartz Commercial |
$209.19
|
| Rate for Payer: The Alliance Commercial |
$183.50
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Opiate Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Opiate Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Opiate Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Opiates Meconium
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2942889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
