|
Quantiferon TB Gold
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
979850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$404.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.38
|
| Rate for Payer: Aetna Managed Medicare |
$104.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.64
|
| Rate for Payer: Anthem Medicare Advantage |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.00
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$104.00
|
| Rate for Payer: Health EOS Commercial |
$399.86
|
| Rate for Payer: HFN Commercial |
$413.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$104.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$359.42
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.34
|
| Rate for Payer: Quartz Beloit One Network |
$220.15
|
| Rate for Payer: Quartz Commercial |
$292.03
|
| Rate for Payer: Quartz Medicare Advantage |
$104.00
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.00
|
| Rate for Payer: United Healthcare PPO |
$336.96
|
| Rate for Payer: WEA Trust Commercial |
$247.10
|
| Rate for Payer: Wellcare Medicare |
$104.00
|
| Rate for Payer: WPS Commercial |
$332.77
|
|
|
Quantiferon TB Gold
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
979850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$457.60 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.38
|
| Rate for Payer: Aetna Managed Medicare |
$104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.00
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$426.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.00
|
| Rate for Payer: Health EOS Commercial |
$408.84
|
| Rate for Payer: HFN Commercial |
$426.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$359.42
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$426.82
|
| Rate for Payer: Quartz Beloit One Network |
$197.68
|
| Rate for Payer: Quartz Commercial |
$256.09
|
| Rate for Payer: Quartz Medicare Advantage |
$104.00
|
| Rate for Payer: The Alliance Commercial |
$410.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$247.10
|
| Rate for Payer: WPS Commercial |
$457.60
|
|
|
Quantiferon TB Gold
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
979850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.15 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$404.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.12
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: Health EOS Commercial |
$399.86
|
| Rate for Payer: HFN Commercial |
$413.34
|
| Rate for Payer: Multiplan Commercial |
$359.42
|
| Rate for Payer: Preferred Network Access Commercial |
$413.34
|
| Rate for Payer: Quartz Beloit One Network |
$220.15
|
| Rate for Payer: Quartz Commercial |
$269.57
|
| Rate for Payer: WEA Trust Commercial |
$247.10
|
| Rate for Payer: WPS Commercial |
$332.77
|
|
|
Quetiapine (Seroquel) Level
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$54.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.86
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$116.69
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$116.69
|
| Rate for Payer: The Alliance Commercial |
$97.24
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Quetiapine (Seroquel) Level
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.69
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| 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 |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: The Alliance Commercial |
$97.24
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Quetiapine (Seroquel) Level
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
QUICK CAST 2 #5643-10"
|
Facility
|
OP
|
$303.00
|
|
| Hospital Charge Code |
2970233
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.23 |
| Max. Negotiated Rate |
$289.91 |
| Rate for Payer: Aetna Commercial |
$283.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.00
|
| Rate for Payer: Aetna Managed Medicare |
$88.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.01
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$289.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.35
|
| Rate for Payer: Health EOS Commercial |
$280.46
|
| Rate for Payer: HFN Commercial |
$289.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.34
|
| Rate for Payer: Multiplan Commercial |
$252.10
|
| Rate for Payer: NAPHCARE Commercial |
$189.07
|
| Rate for Payer: Preferred Network Access Commercial |
$289.91
|
| Rate for Payer: Quartz Beloit One Network |
$154.41
|
| Rate for Payer: Quartz Commercial |
$204.83
|
| Rate for Payer: Quartz Medicare Advantage |
$189.07
|
| Rate for Payer: The Alliance Commercial |
$157.56
|
| Rate for Payer: WEA Trust Commercial |
$173.32
|
| Rate for Payer: WPS Commercial |
$233.40
|
|
|
QUICK CAST 2 #5643-10"
|
Facility
|
IP
|
$303.00
|
|
| Hospital Charge Code |
2970233
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$154.41 |
| Max. Negotiated Rate |
$289.91 |
| Rate for Payer: Aetna Commercial |
$283.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.01
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$289.91
|
| Rate for Payer: Health EOS Commercial |
$280.46
|
| Rate for Payer: HFN Commercial |
$289.91
|
| Rate for Payer: Multiplan Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$289.91
|
| Rate for Payer: Quartz Beloit One Network |
$154.41
|
| Rate for Payer: Quartz Commercial |
$189.07
|
| Rate for Payer: WEA Trust Commercial |
$173.32
|
| Rate for Payer: WPS Commercial |
$233.40
|
|
|
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 |
$58.24 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$58.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$124.80
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
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 |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
QUICK LOAD COR-KNOT 6 -POUCH 030874
|
Facility
|
OP
|
$2,829.00
|
|
| Hospital Charge Code |
3881342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.80 |
| Max. Negotiated Rate |
$2,706.79 |
| Rate for Payer: Aetna Commercial |
$2,647.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,530.26
|
| Rate for Payer: Aetna Managed Medicare |
$823.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,912.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,471.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,412.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.34
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,706.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,646.48
|
| Rate for Payer: Health EOS Commercial |
$2,618.52
|
| Rate for Payer: HFN Commercial |
$2,706.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,206.62
|
| Rate for Payer: Multiplan Commercial |
$2,353.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,765.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,706.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.66
|
| Rate for Payer: Quartz Commercial |
$1,912.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,765.30
|
| Rate for Payer: The Alliance Commercial |
$1,471.08
|
| Rate for Payer: WEA Trust Commercial |
$1,618.19
|
| Rate for Payer: WPS Commercial |
$2,179.18
|
|
|
QUICK LOAD COR-KNOT 6 -POUCH 030874
|
Facility
|
IP
|
$2,829.00
|
|
| Hospital Charge Code |
3881342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,441.66 |
| Max. Negotiated Rate |
$2,706.79 |
| Rate for Payer: Aetna Commercial |
$2,647.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,530.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.34
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,706.79
|
| Rate for Payer: Health EOS Commercial |
$2,618.52
|
| Rate for Payer: HFN Commercial |
$2,706.79
|
| Rate for Payer: Multiplan Commercial |
$2,353.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,706.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.66
|
| Rate for Payer: Quartz Commercial |
$1,765.30
|
| Rate for Payer: WEA Trust Commercial |
$1,618.19
|
| Rate for Payer: WPS Commercial |
$2,179.18
|
|
|
QUICK LOAD COR-KNOT SINGLE UNIT 030850
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
3381502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$554.11
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
QUICK LOAD COR-KNOT SINGLE UNIT 030850
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
3381502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.59 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Aetna Managed Medicare |
$258.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.82
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: NAPHCARE Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: Quartz Medicare Advantage |
$554.11
|
| Rate for Payer: The Alliance Commercial |
$461.76
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
QUICK SCORE FORM
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2972096
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
QUICK SCORE FORM
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2972096
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Quick Trach Device 2.0Mm
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
3040370
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
Quick Trach Device 2.0Mm
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
3040370
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
Quick Trach Device 4.0Mm
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
3040369
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
Quick Trach Device 4.0Mm
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
3040369
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
Quinidine Level
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
978130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$435.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Aetna Managed Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.21
|
| Rate for Payer: Anthem Medicare Advantage |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.18
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$444.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.18
|
| Rate for Payer: Health EOS Commercial |
$430.40
|
| Rate for Payer: HFN Commercial |
$444.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: NAPHCARE Commercial |
$22.78
|
| Rate for Payer: Preferred Network Access Commercial |
$444.91
|
| Rate for Payer: Quartz Beloit One Network |
$236.96
|
| Rate for Payer: Quartz Commercial |
$314.34
|
| Rate for Payer: Quartz Medicare Advantage |
$15.18
|
| Rate for Payer: The Alliance Commercial |
$60.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.18
|
| Rate for Payer: United Healthcare PPO |
$362.70
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: Wellcare Medicare |
$15.18
|
| Rate for Payer: WPS Commercial |
$358.19
|
|
|
Quinidine Level
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
978130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$435.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.31
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$444.91
|
| Rate for Payer: Health EOS Commercial |
$430.40
|
| Rate for Payer: HFN Commercial |
$444.91
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: Preferred Network Access Commercial |
$444.91
|
| Rate for Payer: Quartz Beloit One Network |
$236.96
|
| Rate for Payer: Quartz Commercial |
$290.16
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: WPS Commercial |
$358.19
|
|
|
Quinidine Level
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
978130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$459.42 |
| Rate for Payer: Aetna Commercial |
$459.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Aetna Managed Medicare |
$15.18
|
| Rate for Payer: Anthem Medicare Advantage |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.18
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$459.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.18
|
| Rate for Payer: Health EOS Commercial |
$440.08
|
| Rate for Payer: HFN Commercial |
$459.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: NAPHCARE Commercial |
$22.78
|
| Rate for Payer: Preferred Network Access Commercial |
$459.42
|
| Rate for Payer: Quartz Beloit One Network |
$212.78
|
| Rate for Payer: Quartz Commercial |
$275.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15.18
|
| Rate for Payer: The Alliance Commercial |
$59.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.18
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: WPS Commercial |
$66.81
|
|
|
Quinton Curl Cath Doubled Cuff
|
Facility
|
IP
|
$1,327.00
|
|
| Hospital Charge Code |
3603563
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$676.24 |
| Max. Negotiated Rate |
$1,269.67 |
| Rate for Payer: Aetna Commercial |
$1,242.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.44
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,269.67
|
| Rate for Payer: Health EOS Commercial |
$1,228.27
|
| Rate for Payer: HFN Commercial |
$1,269.67
|
| Rate for Payer: Multiplan Commercial |
$1,104.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.67
|
| Rate for Payer: Quartz Beloit One Network |
$676.24
|
| Rate for Payer: Quartz Commercial |
$828.05
|
| Rate for Payer: WEA Trust Commercial |
$759.04
|
| Rate for Payer: WPS Commercial |
$1,022.19
|
|
|
Quinton Curl Cath Doubled Cuff
|
Facility
|
OP
|
$1,327.00
|
|
| Hospital Charge Code |
3603563
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$386.42 |
| Max. Negotiated Rate |
$1,269.67 |
| Rate for Payer: Aetna Commercial |
$1,242.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.87
|
| Rate for Payer: Aetna Managed Medicare |
$386.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$897.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$690.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$662.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.44
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,269.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$772.31
|
| Rate for Payer: Health EOS Commercial |
$1,228.27
|
| Rate for Payer: HFN Commercial |
$1,269.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.06
|
| Rate for Payer: Multiplan Commercial |
$1,104.06
|
| Rate for Payer: NAPHCARE Commercial |
$828.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.67
|
| Rate for Payer: Quartz Beloit One Network |
$676.24
|
| Rate for Payer: Quartz Commercial |
$897.05
|
| Rate for Payer: Quartz Medicare Advantage |
$828.05
|
| Rate for Payer: The Alliance Commercial |
$690.04
|
| Rate for Payer: WEA Trust Commercial |
$759.04
|
| Rate for Payer: WPS Commercial |
$1,022.19
|
|
