|
QUICK CAST 2 #5643-10"
|
Facility
|
OP
|
$303.00
|
|
| Hospital Charge Code |
2970233
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$1,212.00 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.58
|
| Rate for Payer: Aetna Managed Medicare |
$84.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.59
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$278.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.56
|
| Rate for Payer: Health EOS Commercial |
$269.67
|
| Rate for Payer: HFN Commercial |
$278.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.25
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: NAPHCARE Commercial |
$181.80
|
| Rate for Payer: Preferred Network Access Commercial |
$278.76
|
| Rate for Payer: Quartz Beloit One Network |
$148.47
|
| Rate for Payer: Quartz Commercial |
$196.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.80
|
| Rate for Payer: The Alliance Commercial |
$1,212.00
|
| Rate for Payer: WEA Trust Commercial |
$166.65
|
| Rate for Payer: WPS Commercial |
$224.43
|
|
|
QUICKIE PRIME 1/4 X 1/16 IN 301011-000
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
2965787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Aetna Managed Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.92
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$130.00
|
| Rate for Payer: Quartz Medicare Advantage |
$120.00
|
| Rate for Payer: The Alliance Commercial |
$800.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
QUICKIE PRIME 1/4 X 1/16 IN 301011-000
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
2965787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Health EOS Commercial |
$178.00
|
| Rate for Payer: HFN Commercial |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$184.00
|
| Rate for Payer: Quartz Beloit One Network |
$98.00
|
| Rate for Payer: Quartz Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
QUICK LOAD COR-KNOT 6 -POUCH 030874
|
Facility
|
IP
|
$2,829.00
|
|
| Hospital Charge Code |
3881342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.21 |
| Max. Negotiated Rate |
$2,602.68 |
| Rate for Payer: Aetna Commercial |
$2,546.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,499.37
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,602.68
|
| Rate for Payer: Health EOS Commercial |
$2,517.81
|
| Rate for Payer: HFN Commercial |
$2,602.68
|
| Rate for Payer: Multiplan Commercial |
$2,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,697.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,602.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.21
|
| Rate for Payer: Quartz Commercial |
$1,697.40
|
| Rate for Payer: WEA Trust Commercial |
$1,555.95
|
| Rate for Payer: WPS Commercial |
$2,095.44
|
|
|
QUICK LOAD COR-KNOT 6 -POUCH 030874
|
Facility
|
OP
|
$2,829.00
|
|
| Hospital Charge Code |
3881342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.12 |
| Max. Negotiated Rate |
$11,316.00 |
| Rate for Payer: Aetna Commercial |
$2,546.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.94
|
| Rate for Payer: Aetna Managed Medicare |
$792.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,838.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,414.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,357.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,499.37
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,602.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.11
|
| Rate for Payer: Health EOS Commercial |
$2,517.81
|
| Rate for Payer: HFN Commercial |
$2,602.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,121.75
|
| Rate for Payer: Multiplan Commercial |
$2,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,697.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,602.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.21
|
| Rate for Payer: Quartz Commercial |
$1,838.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,697.40
|
| Rate for Payer: The Alliance Commercial |
$11,316.00
|
| Rate for Payer: WEA Trust Commercial |
$1,555.95
|
| Rate for Payer: WPS Commercial |
$2,095.44
|
|
|
QUICK LOAD COR-KNOT SINGLE UNIT 030850
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
3381502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Aetna Managed Medicare |
$248.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.92
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: Quartz Medicare Advantage |
$532.80
|
| Rate for Payer: The Alliance Commercial |
$3,552.00
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
QUICK LOAD COR-KNOT SINGLE UNIT 030850
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
3381502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.12 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$532.80
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
QUICK SCORE FORM
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2972096
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
QUICK SCORE FORM
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2972096
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Quick Trach Device 2.0Mm
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
3040370
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
Quick Trach Device 2.0Mm
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
3040370
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
Quick Trach Device 4.0Mm
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
3040369
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
Quick Trach Device 4.0Mm
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
3040369
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
Quinidine Level
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
978130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Anthem Medicare Advantage |
$14.60
|
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Aetna Managed Medicare |
$14.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.24
|
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.60
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$427.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.21
|
| Rate for Payer: Dean Health Medicaid |
$15.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.60
|
| Rate for Payer: Health EOS Commercial |
$413.85
|
| Rate for Payer: HFN Commercial |
$427.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.60
|
| Rate for Payer: Managed Health Services Medicaid |
$15.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.60
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.09
|
| Rate for Payer: Quartz Beloit One Network |
$227.85
|
| Rate for Payer: Quartz Commercial |
$302.25
|
| Rate for Payer: Quartz Medicare Advantage |
$14.60
|
| Rate for Payer: The Alliance Commercial |
$58.40
|
| Rate for Payer: United Healthcare Medicaid |
$15.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.60
|
| Rate for Payer: United Healthcare PPO |
$348.75
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: Wellcare Medicare |
$14.60
|
| Rate for Payer: WMAP Medicaid |
$15.09
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
Quinidine Level
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
978130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Aetna Commercial |
$441.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$441.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.00
|
| Rate for Payer: Health EOS Commercial |
$423.15
|
| Rate for Payer: HFN Commercial |
$441.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.54
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.75
|
| Rate for Payer: Quartz Beloit One Network |
$204.60
|
| Rate for Payer: Quartz Commercial |
$265.05
|
| Rate for Payer: The Alliance Commercial |
$232.50
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
Quinidine Level
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
978130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$227.85 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.45
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$427.80
|
| Rate for Payer: Health EOS Commercial |
$413.85
|
| Rate for Payer: HFN Commercial |
$427.80
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: NAPHCARE Commercial |
$279.00
|
| Rate for Payer: Preferred Network Access Commercial |
$427.80
|
| Rate for Payer: Quartz Beloit One Network |
$227.85
|
| Rate for Payer: Quartz Commercial |
$279.00
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
Quinton Curl Cath Doubled Cuff
|
Facility
|
OP
|
$1,327.00
|
|
| Hospital Charge Code |
3603563
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$371.56 |
| Max. Negotiated Rate |
$5,308.00 |
| Rate for Payer: Aetna Commercial |
$1,194.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.22
|
| Rate for Payer: Aetna Managed Medicare |
$371.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$862.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.31
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,220.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.59
|
| Rate for Payer: Health EOS Commercial |
$1,181.03
|
| Rate for Payer: HFN Commercial |
$1,220.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$995.25
|
| Rate for Payer: Multiplan Commercial |
$1,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.84
|
| Rate for Payer: Quartz Beloit One Network |
$650.23
|
| Rate for Payer: Quartz Commercial |
$862.55
|
| Rate for Payer: Quartz Medicare Advantage |
$796.20
|
| Rate for Payer: The Alliance Commercial |
$5,308.00
|
| Rate for Payer: WEA Trust Commercial |
$729.85
|
| Rate for Payer: WPS Commercial |
$982.91
|
|
|
Quinton Curl Cath Doubled Cuff
|
Facility
|
IP
|
$1,327.00
|
|
| Hospital Charge Code |
3603563
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$650.23 |
| Max. Negotiated Rate |
$1,220.84 |
| Rate for Payer: Aetna Commercial |
$1,194.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.31
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,220.84
|
| Rate for Payer: Health EOS Commercial |
$1,181.03
|
| Rate for Payer: HFN Commercial |
$1,220.84
|
| Rate for Payer: Multiplan Commercial |
$1,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.84
|
| Rate for Payer: Quartz Beloit One Network |
$650.23
|
| Rate for Payer: Quartz Commercial |
$796.20
|
| Rate for Payer: WEA Trust Commercial |
$729.85
|
| Rate for Payer: WPS Commercial |
$982.91
|
|
|
Rabies Vaccine Titer
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3259497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$133.40 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.85
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$133.40
|
| Rate for Payer: Health EOS Commercial |
$129.05
|
| Rate for Payer: HFN Commercial |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: NAPHCARE Commercial |
$87.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.40
|
| Rate for Payer: Quartz Beloit One Network |
$71.05
|
| Rate for Payer: Quartz Commercial |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$79.75
|
| Rate for Payer: WPS Commercial |
$107.40
|
|
|
Rabies Vaccine Titer
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3259497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Aetna Commercial |
$137.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.70
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$137.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.00
|
| Rate for Payer: Health EOS Commercial |
$131.95
|
| Rate for Payer: HFN Commercial |
$137.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.69
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Preferred Network Access Commercial |
$137.75
|
| Rate for Payer: Quartz Beloit One Network |
$63.80
|
| Rate for Payer: Quartz Commercial |
$82.65
|
| Rate for Payer: The Alliance Commercial |
$72.50
|
| Rate for Payer: WEA Trust Commercial |
$79.75
|
| Rate for Payer: WPS Commercial |
$107.40
|
|
|
Rabies Vaccine Titer
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3259497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$133.40 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.70
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.07
|
| Rate for Payer: Anthem Medicaid |
$17.47
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$133.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.14
|
| Rate for Payer: Dean Health Medicaid |
$17.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$129.05
|
| Rate for Payer: HFN Commercial |
$133.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Managed Health Services Medicaid |
$18.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.47
|
| Rate for Payer: Quartz Beloit One Network |
$71.05
|
| Rate for Payer: Quartz Commercial |
$94.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$67.64
|
| Rate for Payer: United Healthcare Medicaid |
$17.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare PPO |
$108.75
|
| Rate for Payer: WEA Trust Commercial |
$79.75
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
| Rate for Payer: WMAP Medicaid |
$17.47
|
| Rate for Payer: WPS Commercial |
$107.40
|
|
|
Rad Dosimetry Calculation Plan 7730026
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 77300 26
|
| Hospital Charge Code |
5258628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$307.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.40
|
| Rate for Payer: Health EOS Commercial |
$294.84
|
| Rate for Payer: HFN Commercial |
$307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.90
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Preferred Network Access Commercial |
$307.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.56
|
| Rate for Payer: Quartz Commercial |
$184.68
|
| Rate for Payer: The Alliance Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Radex Ribs Uni W/Posteroant 71101
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
4538771
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.72 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.80
|
| Rate for Payer: Health EOS Commercial |
$262.08
|
| Rate for Payer: HFN Commercial |
$273.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.04
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$273.60
|
| Rate for Payer: Quartz Beloit One Network |
$126.72
|
| Rate for Payer: Quartz Commercial |
$164.16
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$213.32
|
|
|
Radex Ribs Uni W/Posteroant 7110126
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 71101 26
|
| Hospital Charge Code |
4538772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.22 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.80
|
| Rate for Payer: Health EOS Commercial |
$262.08
|
| Rate for Payer: HFN Commercial |
$273.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.22
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$273.60
|
| Rate for Payer: Quartz Beloit One Network |
$126.72
|
| Rate for Payer: Quartz Commercial |
$164.16
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$213.32
|
|
|
RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS 72120-26
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 72120 26
|
| Hospital Charge Code |
6219419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
