|
CMV Genotype
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 87910
|
| Hospital Charge Code |
4732608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$344.96 |
| Max. Negotiated Rate |
$647.68 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$422.40
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
CNSLT BEFORE SCREEN COLONOSCOPY S0285
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0285
|
| Hospital Charge Code |
6180167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.60
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: HFN Commercial |
$48.45
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: The Alliance Commercial |
$25.50
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$41,795.00
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$15,034.00 |
| Max. Negotiated Rate |
$41,795.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,034.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,728.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,086.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,833.68
|
| Rate for Payer: Anthem Medicare Advantage |
$15,034.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,034.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,034.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,034.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,457.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,034.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,420.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,034.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,034.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,034.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,034.00
|
| Rate for Payer: NAPHCARE Commercial |
$22,551.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15,034.00
|
| Rate for Payer: The Alliance Commercial |
$41,795.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,034.00
|
| Rate for Payer: United Healthcare PPO |
$23,682.36
|
| Rate for Payer: Wellcare Medicare |
$15,034.00
|
|
|
Cobalt Level
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
1038893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$178.20
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Cobalt Level
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
1038893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Aetna Managed Medicare |
$21.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.45
|
| Rate for Payer: Anthem Medicaid |
$22.69
|
| Rate for Payer: Anthem Medicare Advantage |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.96
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Dean Health Medicaid |
$22.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.96
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.96
|
| Rate for Payer: Managed Health Services Medicaid |
$23.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.96
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$32.94
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$193.05
|
| Rate for Payer: Quartz Medicare Advantage |
$21.96
|
| Rate for Payer: The Alliance Commercial |
$87.84
|
| Rate for Payer: United Healthcare Medicaid |
$22.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.96
|
| Rate for Payer: United Healthcare PPO |
$222.75
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: Wellcare Medicare |
$21.96
|
| Rate for Payer: WMAP Medicaid |
$22.69
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Cobalt Level
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
1038893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna Commercial |
$282.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$282.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.20
|
| Rate for Payer: Health EOS Commercial |
$270.27
|
| Rate for Payer: HFN Commercial |
$282.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.52
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$282.15
|
| Rate for Payer: Quartz Beloit One Network |
$130.68
|
| Rate for Payer: Quartz Commercial |
$169.29
|
| Rate for Payer: The Alliance Commercial |
$148.50
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Coban
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
3153477
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
Coban
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
3153477
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
COBRA ADHERE XL
|
Facility
|
IP
|
$33,832.00
|
|
| Hospital Charge Code |
2965109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16,577.68 |
| Max. Negotiated Rate |
$31,125.44 |
| Rate for Payer: Aetna Commercial |
$30,448.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,095.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17,930.96
|
| Rate for Payer: Cash Price |
$10,149.60
|
| Rate for Payer: Cigna Commercial |
$31,125.44
|
| Rate for Payer: Health EOS Commercial |
$30,110.48
|
| Rate for Payer: HFN Commercial |
$31,125.44
|
| Rate for Payer: Multiplan Commercial |
$27,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$20,299.20
|
| Rate for Payer: Preferred Network Access Commercial |
$31,125.44
|
| Rate for Payer: Quartz Beloit One Network |
$16,577.68
|
| Rate for Payer: Quartz Commercial |
$20,299.20
|
| Rate for Payer: WEA Trust Commercial |
$18,607.60
|
| Rate for Payer: WPS Commercial |
$25,059.36
|
|
|
COBRA ADHERE XL
|
Facility
|
OP
|
$33,832.00
|
|
| Hospital Charge Code |
2965109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,472.96 |
| Max. Negotiated Rate |
$135,328.00 |
| Rate for Payer: Aetna Commercial |
$30,448.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,095.52
|
| Rate for Payer: Aetna Managed Medicare |
$9,472.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,990.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,916.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,239.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17,930.96
|
| Rate for Payer: Cash Price |
$10,149.60
|
| Rate for Payer: Cigna Commercial |
$31,125.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,932.39
|
| Rate for Payer: Health EOS Commercial |
$30,110.48
|
| Rate for Payer: HFN Commercial |
$31,125.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,374.00
|
| Rate for Payer: Multiplan Commercial |
$27,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$20,299.20
|
| Rate for Payer: Preferred Network Access Commercial |
$31,125.44
|
| Rate for Payer: Quartz Beloit One Network |
$16,577.68
|
| Rate for Payer: Quartz Commercial |
$21,990.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20,299.20
|
| Rate for Payer: The Alliance Commercial |
$135,328.00
|
| Rate for Payer: WEA Trust Commercial |
$18,607.60
|
| Rate for Payer: WPS Commercial |
$25,059.36
|
|
|
COBRA BIPOLAR INSERT
|
Facility
|
IP
|
$14,644.00
|
|
| Hospital Charge Code |
2965110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,175.56 |
| Max. Negotiated Rate |
$13,472.48 |
| Rate for Payer: Aetna Commercial |
$13,179.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,593.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,761.32
|
| Rate for Payer: Cash Price |
$4,393.20
|
| Rate for Payer: Cigna Commercial |
$13,472.48
|
| Rate for Payer: Health EOS Commercial |
$13,033.16
|
| Rate for Payer: HFN Commercial |
$13,472.48
|
| Rate for Payer: Multiplan Commercial |
$11,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,786.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,472.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,175.56
|
| Rate for Payer: Quartz Commercial |
$8,786.40
|
| Rate for Payer: WEA Trust Commercial |
$8,054.20
|
| Rate for Payer: WPS Commercial |
$10,846.81
|
|
|
COBRA BIPOLAR INSERT
|
Facility
|
OP
|
$14,644.00
|
|
| Hospital Charge Code |
2965110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,100.32 |
| Max. Negotiated Rate |
$58,576.00 |
| Rate for Payer: Aetna Commercial |
$13,179.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,593.84
|
| Rate for Payer: Aetna Managed Medicare |
$4,100.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,518.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,322.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,029.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,761.32
|
| Rate for Payer: Cash Price |
$4,393.20
|
| Rate for Payer: Cigna Commercial |
$13,472.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,194.78
|
| Rate for Payer: Health EOS Commercial |
$13,033.16
|
| Rate for Payer: HFN Commercial |
$13,472.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,983.00
|
| Rate for Payer: Multiplan Commercial |
$11,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,786.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,472.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,175.56
|
| Rate for Payer: Quartz Commercial |
$9,518.60
|
| Rate for Payer: Quartz Medicare Advantage |
$8,786.40
|
| Rate for Payer: The Alliance Commercial |
$58,576.00
|
| Rate for Payer: WEA Trust Commercial |
$8,054.20
|
| Rate for Payer: WPS Commercial |
$10,846.81
|
|
|
COBRA CABLE
|
Facility
|
OP
|
$9,015.00
|
|
| Hospital Charge Code |
2965111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,524.20 |
| Max. Negotiated Rate |
$36,060.00 |
| Rate for Payer: Aetna Commercial |
$8,113.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,752.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,524.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,859.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,507.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,327.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,777.95
|
| Rate for Payer: Cash Price |
$2,704.50
|
| Rate for Payer: Cigna Commercial |
$8,293.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,044.79
|
| Rate for Payer: Health EOS Commercial |
$8,023.35
|
| Rate for Payer: HFN Commercial |
$8,293.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,761.25
|
| Rate for Payer: Multiplan Commercial |
$7,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,409.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,293.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,417.35
|
| Rate for Payer: Quartz Commercial |
$5,859.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,409.00
|
| Rate for Payer: The Alliance Commercial |
$36,060.00
|
| Rate for Payer: WEA Trust Commercial |
$4,958.25
|
| Rate for Payer: WPS Commercial |
$6,677.41
|
|
|
COBRA CABLE
|
Facility
|
IP
|
$9,015.00
|
|
| Hospital Charge Code |
2965111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,417.35 |
| Max. Negotiated Rate |
$8,293.80 |
| Rate for Payer: Aetna Commercial |
$8,113.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,752.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,777.95
|
| Rate for Payer: Cash Price |
$2,704.50
|
| Rate for Payer: Cigna Commercial |
$8,293.80
|
| Rate for Payer: Health EOS Commercial |
$8,023.35
|
| Rate for Payer: HFN Commercial |
$8,293.80
|
| Rate for Payer: Multiplan Commercial |
$7,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,409.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,293.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,417.35
|
| Rate for Payer: Quartz Commercial |
$5,409.00
|
| Rate for Payer: WEA Trust Commercial |
$4,958.25
|
| Rate for Payer: WPS Commercial |
$6,677.41
|
|
|
.Cocaine and Metabolites Confirmation
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3856679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Aetna Managed Medicare |
$57.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.84
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$134.55
|
| Rate for Payer: Quartz Medicare Advantage |
$124.20
|
| Rate for Payer: The Alliance Commercial |
$828.00
|
| Rate for Payer: United Healthcare PPO |
$155.25
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
.Cocaine and Metabolites Confirmation
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3856679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$190.44 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$124.20
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
.Cocaine and Metabolites Confirmation
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3856679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$196.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$188.37
|
| Rate for Payer: HFN Commercial |
$196.65
|
| 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 |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$196.65
|
| Rate for Payer: Quartz Beloit One Network |
$91.08
|
| Rate for Payer: Quartz Commercial |
$117.99
|
| Rate for Payer: The Alliance Commercial |
$103.50
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
Cocaine Level With Metabolites Blood
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
977907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Aetna Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$156.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.00
|
| Rate for Payer: Health EOS Commercial |
$150.15
|
| Rate for Payer: HFN Commercial |
$156.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.35
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.75
|
| Rate for Payer: Quartz Beloit One Network |
$72.60
|
| Rate for Payer: Quartz Commercial |
$94.05
|
| Rate for Payer: The Alliance Commercial |
$82.50
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Cocaine Level With Metabolites Blood
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
977907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Cocaine Level With Metabolites Blood
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
977907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.15
|
| Rate for Payer: Anthem Medicaid |
$63.40
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.33
|
| Rate for Payer: Dean Health Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Managed Health Services Medicaid |
$65.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$107.25
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: United Healthcare Medicaid |
$63.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Healthcare PPO |
$123.75
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Cocaine Level With Metabolites Serum
|
Professional
|
Both
|
$87.10
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
4308705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Aetna Commercial |
$82.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.91
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cigna Commercial |
$82.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.26
|
| Rate for Payer: Health EOS Commercial |
$79.26
|
| Rate for Payer: HFN Commercial |
$82.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.35
|
| Rate for Payer: Multiplan Commercial |
$69.68
|
| Rate for Payer: Preferred Network Access Commercial |
$82.74
|
| Rate for Payer: Quartz Beloit One Network |
$38.32
|
| Rate for Payer: Quartz Commercial |
$49.65
|
| Rate for Payer: The Alliance Commercial |
$43.55
|
| Rate for Payer: WEA Trust Commercial |
$47.90
|
| Rate for Payer: WPS Commercial |
$64.51
|
|
|
Cocaine Level With Metabolites Serum
|
Facility
|
IP
|
$87.10
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
4308705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$80.13 |
| Rate for Payer: Aetna Commercial |
$78.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.16
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cigna Commercial |
$80.13
|
| Rate for Payer: Health EOS Commercial |
$77.52
|
| Rate for Payer: HFN Commercial |
$80.13
|
| Rate for Payer: Multiplan Commercial |
$69.68
|
| Rate for Payer: NAPHCARE Commercial |
$52.26
|
| Rate for Payer: Preferred Network Access Commercial |
$80.13
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$52.26
|
| Rate for Payer: WEA Trust Commercial |
$47.90
|
| Rate for Payer: WPS Commercial |
$64.51
|
|
|
Cocaine Level With Metabolites Serum
|
Facility
|
OP
|
$87.10
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
4308705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$78.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.91
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.15
|
| Rate for Payer: Anthem Medicaid |
$63.40
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cigna Commercial |
$80.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.74
|
| Rate for Payer: Dean Health Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$77.52
|
| Rate for Payer: HFN Commercial |
$80.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Managed Health Services Medicaid |
$65.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$69.68
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$80.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$56.62
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: United Healthcare Medicaid |
$63.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Healthcare PPO |
$65.32
|
| Rate for Payer: WEA Trust Commercial |
$47.90
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$64.51
|
|
|
Cocaine Meconium
|
Professional
|
Both
|
$38.00
|
|
| Hospital Charge Code |
2942887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.80
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: HFN Commercial |
$36.10
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Cocaine Meconium
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2942887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
