|
Oxisensor
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3040345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| 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: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Oxycodone
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
5144674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Oxycodone
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
5144674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Oxycodone
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
5144674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$83.26 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.44
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| 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 |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Oxycodone & Metabolite, Quantitative, Serum
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
4670608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$74.26
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
Oxycodone & Metabolite, Quantitative, Serum
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
4670608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.26
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.82
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$74.26
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$80.44
|
| Rate for Payer: Quartz Medicare Advantage |
$74.26
|
| Rate for Payer: The Alliance Commercial |
$61.88
|
| Rate for Payer: United Healthcare PPO |
$92.82
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
Oxycodone & Metabolite, Quantitative, Serum
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
4670608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$117.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.26
|
| Rate for Payer: Health EOS Commercial |
$112.62
|
| Rate for Payer: HFN Commercial |
$117.57
|
| 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 |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$117.57
|
| Rate for Payer: Quartz Beloit One Network |
$54.45
|
| Rate for Payer: Quartz Commercial |
$70.54
|
| Rate for Payer: The Alliance Commercial |
$61.88
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
Oxygen Connecting Tubing
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040346
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Oxygen Connecting Tubing
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040346
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Oxygen Dissociation, P50
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
4568606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$1,310.09 |
| Rate for Payer: Aetna Commercial |
$1,310.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.87
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,310.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$689.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.87
|
| Rate for Payer: Health EOS Commercial |
$1,254.93
|
| Rate for Payer: HFN Commercial |
$1,310.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: NAPHCARE Commercial |
$20.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.09
|
| Rate for Payer: Quartz Beloit One Network |
$606.78
|
| Rate for Payer: Quartz Commercial |
$786.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13.87
|
| Rate for Payer: The Alliance Commercial |
$54.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.87
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$61.04
|
|
|
Oxygen Dissociation, P50
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
4568606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$675.73 |
| Max. Negotiated Rate |
$1,268.72 |
| Rate for Payer: Aetna Commercial |
$1,241.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.89
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,268.72
|
| Rate for Payer: Health EOS Commercial |
$1,227.35
|
| Rate for Payer: HFN Commercial |
$1,268.72
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.72
|
| Rate for Payer: Quartz Beloit One Network |
$675.73
|
| Rate for Payer: Quartz Commercial |
$827.42
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$1,021.42
|
|
|
Oxygen Dissociation, P50
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
4568606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$1,268.72 |
| Rate for Payer: Aetna Commercial |
$1,241.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.87
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,268.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.87
|
| Rate for Payer: Health EOS Commercial |
$1,227.35
|
| Rate for Payer: HFN Commercial |
$1,268.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: NAPHCARE Commercial |
$20.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.72
|
| Rate for Payer: Quartz Beloit One Network |
$675.73
|
| Rate for Payer: Quartz Commercial |
$896.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.87
|
| Rate for Payer: The Alliance Commercial |
$55.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.87
|
| Rate for Payer: United Healthcare PPO |
$1,034.28
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: Wellcare Medicare |
$13.87
|
| Rate for Payer: WPS Commercial |
$1,021.42
|
|
|
OXYMASK ADULT OM-1125-8
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2972417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
OXYMASK ADULT OM-1125-8
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2972417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
OXYMASK ETCO2 ADULT OM-2125-8SLM
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$42.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.66
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$91.73
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$91.73
|
| Rate for Payer: The Alliance Commercial |
$3.79
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
OXYMASK ETCO2 ADULT OM-2125-8SLM
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
OXYMASK ETCO2 KID OK-2125-8SLM
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
OXYMASK ETCO2 KID OK-2125-8SLM
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$3.79
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
Oxymetazoline Nasal Spray 15ml [Med]
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
2974905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Oxymetazoline Nasal Spray 15ml [Med]
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
2974905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Oxytocin 20units/1ml vial [Med]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2974967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Oxytocin 20units/1ml vial [Med]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2974967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Oxytocin (Pitocin) 10units/ml [MED]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
3260805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$10.61
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Oxytocin (Pitocin) 10units/ml [MED]
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
3260805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.89
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.26
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.61
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$11.49
|
| Rate for Payer: Quartz Medicare Advantage |
$10.61
|
| Rate for Payer: The Alliance Commercial |
$8.84
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Pace Gen Change Dual Lead
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3052390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,473.25 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,954.32
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
