|
Drug Toxicology Methadone, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Nicotine, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| 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 |
$65.21
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Toxicology Nicotine, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$62.84
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| 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 |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Nicotine, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Opioids, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$62.84
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| 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 |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Opioids, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Opioids, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| 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 |
$65.21
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Toxicology Panel, Saliva
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$512.84 |
| Rate for Payer: Aetna Commercial |
$501.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.40
|
| 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 |
$295.44
|
| 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 |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$512.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$496.12
|
| Rate for Payer: HFN Commercial |
$512.84
|
| 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 |
$445.95
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$512.84
|
| Rate for Payer: Quartz Beloit One Network |
$273.15
|
| Rate for Payer: Quartz Commercial |
$362.34
|
| 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 |
$418.08
|
| Rate for Payer: WEA Trust Commercial |
$306.59
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$412.88
|
|
|
Drug Toxicology Panel, Saliva
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$273.15 |
| Max. Negotiated Rate |
$512.84 |
| Rate for Payer: Aetna Commercial |
$501.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.44
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$512.84
|
| Rate for Payer: Health EOS Commercial |
$496.12
|
| Rate for Payer: HFN Commercial |
$512.84
|
| Rate for Payer: Multiplan Commercial |
$445.95
|
| Rate for Payer: Preferred Network Access Commercial |
$512.84
|
| Rate for Payer: Quartz Beloit One Network |
$273.15
|
| Rate for Payer: Quartz Commercial |
$334.46
|
| Rate for Payer: WEA Trust Commercial |
$306.59
|
| Rate for Payer: WPS Commercial |
$412.88
|
|
|
Drug Toxicology Panel, Saliva
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$529.57 |
| Rate for Payer: Aetna Commercial |
$529.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.40
|
| 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 |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$529.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$507.27
|
| Rate for Payer: HFN Commercial |
$529.57
|
| 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 |
$445.95
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$529.57
|
| Rate for Payer: Quartz Beloit One Network |
$245.27
|
| Rate for Payer: Quartz Commercial |
$317.74
|
| 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 |
$306.59
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Toxicology PCP, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$62.84
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| 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 |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology PCP, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| 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 |
$65.21
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Toxicology PCP, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Zolpidem, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$62.84
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| 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 |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Drug Toxicology Zolpidem, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| 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 |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| 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 |
$65.21
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Toxicology Zolpidem, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
DRVVT 1:1 Mix
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1039001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$9.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.54
|
| Rate for Payer: Anthem Medicare Advantage |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.96
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.96
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$14.94
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$9.96
|
| Rate for Payer: The Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.96
|
| Rate for Payer: United Healthcare PPO |
$141.18
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: Wellcare Medicare |
$9.96
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
DRVVT 1:1 Mix
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1039001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.24 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$112.94
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
DRVVT 1:1 Mix
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
1039001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$178.83 |
| Rate for Payer: Aetna Commercial |
$178.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$9.96
|
| Rate for Payer: Anthem Medicare Advantage |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.96
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$178.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.96
|
| Rate for Payer: Health EOS Commercial |
$171.30
|
| Rate for Payer: HFN Commercial |
$178.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$14.94
|
| Rate for Payer: Preferred Network Access Commercial |
$178.83
|
| Rate for Payer: Quartz Beloit One Network |
$82.83
|
| Rate for Payer: Quartz Commercial |
$107.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9.96
|
| Rate for Payer: The Alliance Commercial |
$39.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.96
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$43.84
|
|
|
DRVVT Confirmation
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1038997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$18.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.04
|
| Rate for Payer: Anthem Medicare Advantage |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.70
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.70
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$28.05
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$18.70
|
| Rate for Payer: The Alliance Commercial |
$74.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.70
|
| Rate for Payer: United Healthcare PPO |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: Wellcare Medicare |
$18.70
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
DRVVT Confirmation
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1038997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$18.70
|
| Rate for Payer: Anthem Medicare Advantage |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.70
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.70
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$28.05
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: Quartz Medicare Advantage |
$18.70
|
| Rate for Payer: The Alliance Commercial |
$73.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.70
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$82.28
|
|
|
DRVVT Confirmation
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
1038997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
DRVVT Screen
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2942943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$9.96
|
| Rate for Payer: Anthem Medicare Advantage |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.96
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.96
|
| Rate for Payer: Health EOS Commercial |
$158.05
|
| Rate for Payer: HFN Commercial |
$165.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$14.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.00
|
| Rate for Payer: Quartz Beloit One Network |
$76.42
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9.96
|
| Rate for Payer: The Alliance Commercial |
$39.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.96
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$43.84
|
|
|
DRVVT Screen
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2942943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$104.21
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
DRVVT Screen
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
2942943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$9.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.54
|
| Rate for Payer: Anthem Medicare Advantage |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.96
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.96
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$14.94
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$112.89
|
| Rate for Payer: Quartz Medicare Advantage |
$9.96
|
| Rate for Payer: The Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.96
|
| Rate for Payer: United Healthcare PPO |
$130.26
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: Wellcare Medicare |
$9.96
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
