|
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 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 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
|
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
|
|
|
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
|
|
|
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
|
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
|
|
|
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
|
|
|
Oxcarbazepine (Trileptal) Level
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| 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: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
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
|
|
|
Oxepa
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
Oxepa
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
OXIMETER PULSE FINGER ADULT STERILE LATEX FREE 2601
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
3949324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
OXIMETER PULSE FINGER ADULT STERILE LATEX FREE 2601
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
3949324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$101.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.44
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$217.15
|
| Rate for Payer: The Alliance Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
OXIMETER SENSOR DISP NONIN/ADULT 6000CA
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
4508665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$80.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$172.22
|
| Rate for Payer: The Alliance Commercial |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
OXIMETER SENSOR DISP NONIN/ADULT 6000CA
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
4508665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Oxisensor
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3040345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
