|
.Cocaine and Metabolites Confirmation
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3856679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$60.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.47
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.46
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$129.17
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$139.93
|
| Rate for Payer: Quartz Medicare Advantage |
$129.17
|
| Rate for Payer: The Alliance Commercial |
$107.64
|
| Rate for Payer: United Healthcare PPO |
$161.46
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
.Cocaine and Metabolites Confirmation
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3856679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$204.52 |
| Rate for Payer: Aetna Commercial |
$204.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$204.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.17
|
| Rate for Payer: Health EOS Commercial |
$195.90
|
| Rate for Payer: HFN Commercial |
$204.52
|
| 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 |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$204.52
|
| Rate for Payer: Quartz Beloit One Network |
$94.72
|
| Rate for Payer: Quartz Commercial |
$122.71
|
| Rate for Payer: The Alliance Commercial |
$107.64
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
.Cocaine and Metabolites Confirmation
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3856679
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$129.17
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
Cocaine Level With Metabolites Blood
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
977907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$157.87 |
| Rate for Payer: Aetna Commercial |
$154.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: Health EOS Commercial |
$152.72
|
| Rate for Payer: HFN Commercial |
$157.87
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: Preferred Network Access Commercial |
$157.87
|
| Rate for Payer: Quartz Beloit One Network |
$84.08
|
| Rate for Payer: Quartz Commercial |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
Cocaine Level With Metabolites Blood
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
977907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$154.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$152.72
|
| Rate for Payer: HFN Commercial |
$157.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$157.87
|
| Rate for Payer: Quartz Beloit One Network |
$84.08
|
| Rate for Payer: Quartz Commercial |
$111.54
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$258.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: United Healthcare PPO |
$128.70
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
Cocaine Level With Metabolites Blood
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
977907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$163.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$163.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$156.16
|
| Rate for Payer: HFN Commercial |
$163.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$228.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$163.02
|
| Rate for Payer: Quartz Beloit One Network |
$75.50
|
| Rate for Payer: Quartz Commercial |
$97.81
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$255.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Cocaine Level With Metabolites Serum
|
Facility
|
IP
|
$87.10
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
4308705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$81.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.01
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cigna Commercial |
$83.34
|
| Rate for Payer: Health EOS Commercial |
$80.62
|
| Rate for Payer: HFN Commercial |
$83.34
|
| Rate for Payer: Multiplan Commercial |
$72.47
|
| Rate for Payer: Preferred Network Access Commercial |
$83.34
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$54.35
|
| Rate for Payer: WEA Trust Commercial |
$49.82
|
| Rate for Payer: WPS Commercial |
$67.09
|
|
|
Cocaine Level With Metabolites Serum
|
Professional
|
Both
|
$87.10
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
4308705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$86.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.90
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cigna Commercial |
$86.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$82.43
|
| Rate for Payer: HFN Commercial |
$86.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$228.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$72.47
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$86.05
|
| Rate for Payer: Quartz Beloit One Network |
$39.86
|
| Rate for Payer: Quartz Commercial |
$51.63
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$255.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: WEA Trust Commercial |
$49.82
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Cocaine Level With Metabolites Serum
|
Facility
|
OP
|
$87.10
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
4308705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$81.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.90
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cash Price |
$26.13
|
| Rate for Payer: Cigna Commercial |
$83.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$80.62
|
| Rate for Payer: HFN Commercial |
$83.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$72.47
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$83.34
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$58.88
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$258.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: United Healthcare PPO |
$67.94
|
| Rate for Payer: WEA Trust Commercial |
$49.82
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$67.09
|
|
|
Cocaine Meconium
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2942887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare PPO |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Cocaine Meconium
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2942887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Cocaine Meconium
|
Professional
|
Both
|
$38.00
|
|
| Hospital Charge Code |
2942887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.71
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Cocaine Metabolite Quantitative, Urine
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
5322767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$150.18 |
| Rate for Payer: Aetna Commercial |
$150.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$150.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.85
|
| Rate for Payer: Health EOS Commercial |
$143.85
|
| Rate for Payer: HFN Commercial |
$150.18
|
| 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 |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$150.18
|
| Rate for Payer: Quartz Beloit One Network |
$69.56
|
| Rate for Payer: Quartz Commercial |
$90.11
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Cocaine Metabolite Quantitative, Urine
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
5322767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$44.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: United Healthcare PPO |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Cocaine Metabolite Quantitative, Urine
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
5322767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Cocaine Metabolites Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Cocaine Metabolites Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.95
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Cocaine Metabolites Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Coccidioides Antibodies (IgG, IgM)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5366668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Coccidioides Antibodies (IgG, IgM)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5366668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Coccidioides Antibodies (IgG, IgM)
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5366668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
Coccidioides Antibody
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Coccidioides Antibody
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$47.72 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$32.76
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
Coccidioides Antibody
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$52.49 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$39.75
|
| Rate for Payer: HFN Commercial |
$41.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$41.50
|
| Rate for Payer: Quartz Beloit One Network |
$19.22
|
| Rate for Payer: Quartz Commercial |
$24.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
Coccidioides Antibody
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
