|
Oxalic Acid, 24 Hr Urine w/ Creatinine
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
983352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Oxalic Acid, 24 Hr Urine w/ Creatinine
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
983352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.20
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: HFN Commercial |
$130.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.01
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: The Alliance Commercial |
$68.50
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Oxalic Acid, 24 Hr Urine w/ Creatinine
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
983352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$14.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.99
|
| Rate for Payer: Anthem Medicaid |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.45
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Dean Health Medicaid |
$14.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.45
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.45
|
| Rate for Payer: Managed Health Services Medicaid |
$15.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$21.68
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.93
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.45
|
| Rate for Payer: The Alliance Commercial |
$57.80
|
| Rate for Payer: United Healthcare Medicaid |
$14.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$14.45
|
| Rate for Payer: WMAP Medicaid |
$14.93
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Oxcarbazepine (Trileptal) Level
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$976.00 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| Rate for Payer: Quartz Medicare Advantage |
$146.40
|
| Rate for Payer: The Alliance Commercial |
$976.00
|
| Rate for Payer: United Healthcare PPO |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Oxcarbazepine (Trileptal) Level
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna Commercial |
$231.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$231.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.40
|
| Rate for Payer: Health EOS Commercial |
$222.04
|
| Rate for Payer: HFN Commercial |
$231.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.80
|
| Rate for Payer: Quartz Beloit One Network |
$107.36
|
| Rate for Payer: Quartz Commercial |
$139.08
|
| Rate for Payer: The Alliance Commercial |
$122.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Oxcarbazepine (Trileptal) Level
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
983353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Oxepa
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Oxepa
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
OXIMETER PULSE FINGER ADULT STERILE LATEX FREE 2601
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
3949324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
OXIMETER PULSE FINGER ADULT STERILE LATEX FREE 2601
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
3949324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$97.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.74
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$208.80
|
| Rate for Payer: The Alliance Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
OXIMETER SENSOR DISP NONIN/ADULT 6000CA
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
4508665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
OXIMETER SENSOR DISP NONIN/ADULT 6000CA
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
4508665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$77.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$165.60
|
| Rate for Payer: The Alliance Commercial |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Oxisensor
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3040345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Oxisensor
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3040345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Oxycodone
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
5144674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Oxycodone
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
5144674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: United Healthcare PPO |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Oxycodone
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
5144674
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$80.06 |
| Rate for Payer: Aetna Commercial |
$57.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.00
|
| Rate for Payer: Health EOS Commercial |
$54.60
|
| Rate for Payer: HFN Commercial |
$57.00
|
| 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 |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$57.00
|
| Rate for Payer: Quartz Beloit One Network |
$26.40
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Oxycodone & Metabolite, Quantitative, Serum
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
4670608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.12 |
| Max. Negotiated Rate |
$457.72 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.12
|
| Rate for Payer: Anthem Medicaid |
$63.95
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$114.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
| Rate for Payer: Dean Health Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Managed Health Services Medicaid |
$66.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$457.72
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$89.25
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Oxycodone & Metabolite, Quantitative, Serum
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
4670608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.40
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: HFN Commercial |
$113.05
|
| 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 |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: The Alliance Commercial |
$59.50
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Oxycodone & Metabolite, Quantitative, Serum
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
4670608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Oxygen Connecting Tubing
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040346
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Oxygen Connecting Tubing
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040346
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Oxygen Dissociation, P50
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
4568606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$1,219.92 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$795.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$795.60
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
Oxygen Dissociation, P50
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
4568606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$1,219.92 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Aetna Managed Medicare |
$13.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.14
|
| Rate for Payer: Anthem Medicaid |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.34
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.03
|
| Rate for Payer: Dean Health Medicaid |
$13.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.34
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.34
|
| Rate for Payer: Managed Health Services Medicaid |
$14.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.34
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$20.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.78
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$861.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.34
|
| Rate for Payer: The Alliance Commercial |
$53.36
|
| Rate for Payer: United Healthcare Medicaid |
$13.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.34
|
| Rate for Payer: United Healthcare PPO |
$994.50
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: Wellcare Medicare |
$13.34
|
| Rate for Payer: WMAP Medicaid |
$13.78
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
Oxygen Dissociation, P50
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
4568606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$1,259.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,259.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$663.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$795.60
|
| Rate for Payer: Health EOS Commercial |
$1,206.66
|
| Rate for Payer: HFN Commercial |
$1,259.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.09
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,259.70
|
| Rate for Payer: Quartz Beloit One Network |
$583.44
|
| Rate for Payer: Quartz Commercial |
$755.82
|
| Rate for Payer: The Alliance Commercial |
$663.00
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
