|
DROP DOWN PLUG STEM 5950-67
|
Facility
|
OP
|
$6,407.00
|
|
| Hospital Charge Code |
2967782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,793.96 |
| Max. Negotiated Rate |
$25,628.00 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,510.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,164.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,075.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,585.36
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,805.25
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$4,164.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,844.20
|
| Rate for Payer: The Alliance Commercial |
$25,628.00
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
|
Drug Challenge During Cath
|
Facility
|
OP
|
$2,158.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
4510689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$604.24 |
| Max. Negotiated Rate |
$8,632.00 |
| Rate for Payer: Aetna Commercial |
$1,942.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,855.88
|
| Rate for Payer: Aetna Managed Medicare |
$604.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,402.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,079.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,035.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,143.74
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,207.62
|
| Rate for Payer: Health EOS Commercial |
$1,920.62
|
| Rate for Payer: HFN Commercial |
$1,985.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,618.50
|
| Rate for Payer: Multiplan Commercial |
$1,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,294.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,985.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.42
|
| Rate for Payer: Quartz Commercial |
$1,402.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,294.80
|
| Rate for Payer: The Alliance Commercial |
$8,632.00
|
| Rate for Payer: WEA Trust Commercial |
$1,186.90
|
| Rate for Payer: WPS Commercial |
$1,598.43
|
|
|
Drug Challenge During Cath
|
Facility
|
IP
|
$2,158.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
4510689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,057.42 |
| Max. Negotiated Rate |
$1,985.36 |
| Rate for Payer: Aetna Commercial |
$1,942.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,855.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,143.74
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$1,985.36
|
| Rate for Payer: Health EOS Commercial |
$1,920.62
|
| Rate for Payer: HFN Commercial |
$1,985.36
|
| Rate for Payer: Multiplan Commercial |
$1,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,294.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,985.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.42
|
| Rate for Payer: Quartz Commercial |
$1,294.80
|
| Rate for Payer: WEA Trust Commercial |
$1,186.90
|
| Rate for Payer: WPS Commercial |
$1,598.43
|
|
|
Drug Coated Balloon 40mm-120mm
|
Facility
|
IP
|
$7,037.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
5184612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,448.13 |
| Max. Negotiated Rate |
$6,474.04 |
| Rate for Payer: Aetna Commercial |
$6,333.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,729.61
|
| Rate for Payer: Cash Price |
$2,111.10
|
| Rate for Payer: Cigna Commercial |
$6,474.04
|
| Rate for Payer: Health EOS Commercial |
$6,262.93
|
| Rate for Payer: HFN Commercial |
$6,474.04
|
| Rate for Payer: Multiplan Commercial |
$5,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,222.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,474.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.13
|
| Rate for Payer: Quartz Commercial |
$4,222.20
|
| Rate for Payer: WEA Trust Commercial |
$3,870.35
|
| Rate for Payer: WPS Commercial |
$5,212.31
|
|
|
Drug Coated Balloon 40mm-120mm
|
Facility
|
OP
|
$7,037.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
5184612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,970.36 |
| Max. Negotiated Rate |
$28,148.00 |
| Rate for Payer: Aetna Commercial |
$6,333.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,051.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,970.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,574.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,518.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,377.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,729.61
|
| Rate for Payer: Cash Price |
$2,111.10
|
| Rate for Payer: Cigna Commercial |
$6,474.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,937.91
|
| Rate for Payer: Health EOS Commercial |
$6,262.93
|
| Rate for Payer: HFN Commercial |
$6,474.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,277.75
|
| Rate for Payer: Multiplan Commercial |
$5,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,222.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,474.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.13
|
| Rate for Payer: Quartz Commercial |
$4,574.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,222.20
|
| Rate for Payer: The Alliance Commercial |
$28,148.00
|
| Rate for Payer: WEA Trust Commercial |
$3,870.35
|
| Rate for Payer: WPS Commercial |
$5,212.31
|
|
|
Drug Screen Panel 7, Serum
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| 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 |
$122.43
|
| 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 |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| 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 |
$129.27
|
| 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 |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| 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 |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| 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 |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Drug Screen Panel 7, Serum
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.60
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: HFN Commercial |
$219.45
|
| 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 |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Drug Screen Panel 7, Serum
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Drug Screen Panel 8, Serum
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.60
|
| Rate for Payer: Health EOS Commercial |
$278.46
|
| Rate for Payer: HFN Commercial |
$290.70
|
| 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 |
$244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$290.70
|
| Rate for Payer: Quartz Beloit One Network |
$134.64
|
| Rate for Payer: Quartz Commercial |
$174.42
|
| Rate for Payer: The Alliance Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Drug Screen Panel 8, Serum
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| 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 |
$162.18
|
| 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 |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| 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 |
$171.24
|
| 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 |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| 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 |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| 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 |
$229.50
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Drug Screen Panel 8, Serum
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Drug Screen Panel 9, Meconium
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5290651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Drug Screen Panel 9, Meconium
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5290651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.08 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$291.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$291.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.20
|
| Rate for Payer: Health EOS Commercial |
$279.37
|
| Rate for Payer: HFN Commercial |
$291.65
|
| 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 |
$245.60
|
| Rate for Payer: Preferred Network Access Commercial |
$291.65
|
| Rate for Payer: Quartz Beloit One Network |
$135.08
|
| Rate for Payer: Quartz Commercial |
$174.99
|
| Rate for Payer: The Alliance Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Drug Screen Panel 9, Meconium
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5290651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| 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 |
$162.71
|
| 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 |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| 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 |
$171.80
|
| 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 |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| 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 |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| 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 |
$230.25
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Drug Scrn, Qual, Mult Drugs POC
|
Professional
|
Both
|
$28.00
|
|
| Hospital Charge Code |
1188805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$25.48
|
| Rate for Payer: HFN Commercial |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.60
|
| Rate for Payer: Quartz Beloit One Network |
$12.32
|
| Rate for Payer: Quartz Commercial |
$15.96
|
| Rate for Payer: The Alliance Commercial |
$14.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Drug Toxicology Amphetamines, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| 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 |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Amphetamines, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| 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 |
$60.42
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| 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 |
$63.79
|
| 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 |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| 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 |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| 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 |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Amphetamines, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Barbiturates, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Barbiturates, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| 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 |
$60.42
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| 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 |
$63.79
|
| 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 |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| 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 |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| 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 |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Barbiturates, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| 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 |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Benzodiazepines, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| 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 |
$60.42
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| 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 |
$63.79
|
| 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 |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| 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 |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| 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 |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Benzodiazepines, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| 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 |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Benzodiazepines, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Drug Toxicology Cocaine, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
