|
Drug Toxicology PCP, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170655
|
|
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 Zolpidem, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170657
|
|
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 Zolpidem, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170657
|
|
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 Zolpidem, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170657
|
|
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
|
|
|
DRVVT 1:1 Mix
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1039001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$108.60
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$108.60
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
DRVVT 1:1 Mix
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1039001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Aetna Managed Medicare |
$9.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.90
|
| Rate for Payer: Anthem Medicaid |
$9.90
|
| Rate for Payer: Anthem Medicare Advantage |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.58
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.29
|
| Rate for Payer: Dean Health Medicaid |
$9.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.58
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.58
|
| Rate for Payer: Managed Health Services Medicaid |
$10.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$14.37
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.90
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$117.65
|
| Rate for Payer: Quartz Medicare Advantage |
$9.58
|
| Rate for Payer: The Alliance Commercial |
$38.32
|
| Rate for Payer: United Healthcare Medicaid |
$9.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare PPO |
$135.75
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: Wellcare Medicare |
$9.58
|
| Rate for Payer: WMAP Medicaid |
$9.90
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
DRVVT 1:1 Mix
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1039001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna Commercial |
$171.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$171.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.60
|
| Rate for Payer: Health EOS Commercial |
$164.71
|
| Rate for Payer: HFN Commercial |
$171.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.82
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$171.95
|
| Rate for Payer: Quartz Beloit One Network |
$79.64
|
| Rate for Payer: Quartz Commercial |
$103.17
|
| Rate for Payer: The Alliance Commercial |
$90.50
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
DRVVT Confirmation
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1038997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.85
|
| Rate for Payer: Anthem Medicaid |
$18.58
|
| Rate for Payer: Anthem Medicare Advantage |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.98
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.30
|
| Rate for Payer: Dean Health Medicaid |
$18.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.98
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.98
|
| Rate for Payer: Managed Health Services Medicaid |
$19.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$26.97
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.58
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$17.98
|
| Rate for Payer: The Alliance Commercial |
$71.92
|
| Rate for Payer: United Healthcare Medicaid |
$18.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.98
|
| Rate for Payer: United Healthcare PPO |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: Wellcare Medicare |
$17.98
|
| Rate for Payer: WMAP Medicaid |
$18.58
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
DRVVT Confirmation
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1038997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: HFN Commercial |
$228.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.47
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
DRVVT Confirmation
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1038997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
DRVVT Screen
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2942943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$158.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$158.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.20
|
| Rate for Payer: Health EOS Commercial |
$151.97
|
| Rate for Payer: HFN Commercial |
$158.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.82
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$158.65
|
| Rate for Payer: Quartz Beloit One Network |
$73.48
|
| Rate for Payer: Quartz Commercial |
$95.19
|
| Rate for Payer: The Alliance Commercial |
$83.50
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
DRVVT Screen
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2942943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.90
|
| Rate for Payer: Anthem Medicaid |
$9.90
|
| Rate for Payer: Anthem Medicare Advantage |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.58
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.45
|
| Rate for Payer: Dean Health Medicaid |
$9.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.58
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.58
|
| Rate for Payer: Managed Health Services Medicaid |
$10.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.37
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.90
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$108.55
|
| Rate for Payer: Quartz Medicare Advantage |
$9.58
|
| Rate for Payer: The Alliance Commercial |
$38.32
|
| Rate for Payer: United Healthcare Medicaid |
$9.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare PPO |
$125.25
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: Wellcare Medicare |
$9.58
|
| Rate for Payer: WMAP Medicaid |
$9.90
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
DRVVT Screen
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2942943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$100.20
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
dRVVT Screen w/ Reflex dRVVT Confirm & dRVVT 1:1 Mix
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
4076153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
dRVVT Screen w/ Reflex dRVVT Confirm & dRVVT 1:1 Mix
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
4076153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$38.32 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$9.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.90
|
| Rate for Payer: Anthem Medicaid |
$9.90
|
| Rate for Payer: Anthem Medicare Advantage |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.58
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Dean Health Medicaid |
$9.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.58
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.58
|
| Rate for Payer: Managed Health Services Medicaid |
$10.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.58
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$14.37
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.90
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9.58
|
| Rate for Payer: The Alliance Commercial |
$38.32
|
| Rate for Payer: United Healthcare Medicaid |
$9.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.58
|
| Rate for Payer: United Healthcare PPO |
$18.75
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: Wellcare Medicare |
$9.58
|
| Rate for Payer: WMAP Medicaid |
$9.90
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
dRVVT Screen w/ Reflex dRVVT Confirm & dRVVT 1:1 Mix
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
4076153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.00
|
| Rate for Payer: Health EOS Commercial |
$22.75
|
| Rate for Payer: HFN Commercial |
$23.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.82
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.75
|
| Rate for Payer: Quartz Beloit One Network |
$11.00
|
| Rate for Payer: Quartz Commercial |
$14.25
|
| Rate for Payer: The Alliance Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
dsDNA to TheraTest
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
2798805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.40
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: HFN Commercial |
$51.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
dsDNA to TheraTest
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
2798805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
dsDNA to TheraTest
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
2798805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$54.96 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$13.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.81
|
| Rate for Payer: Anthem Medicaid |
$14.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.74
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Dean Health Medicaid |
$14.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.74
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.74
|
| Rate for Payer: Managed Health Services Medicaid |
$14.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.61
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.20
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.74
|
| Rate for Payer: The Alliance Commercial |
$54.96
|
| Rate for Payer: United Healthcare Medicaid |
$14.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$13.74
|
| Rate for Payer: WMAP Medicaid |
$14.20
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
DTAP-HEP B-IPV Vaccine, IM 90723
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
3397515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
DTAP-HEP B-IPV Vaccine, IM 90723
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
3397515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
DTAP-HEP B-IPV Vaccine, IM 90723
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
3397515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: HFN Commercial |
$202.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.49
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
DTAP-HEP B-IPV Vaccine, IM 90723 VFC Charge
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
5466787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$83.32 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.66
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$19.16
|
| Rate for Payer: Quartz Beloit One Network |
$10.21
|
| Rate for Payer: Quartz Commercial |
$13.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.50
|
| Rate for Payer: The Alliance Commercial |
$83.32
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
DTAP-HEP B-IPV Vaccine, IM 90723 VFC Charge
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
5466787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$179.49 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.49
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
DTAP-HEP B-IPV Vaccine, IM 90723 VFC Charge
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
5466787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$19.16
|
| Rate for Payer: Quartz Beloit One Network |
$10.21
|
| Rate for Payer: Quartz Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
