|
DRIVER TIP CANNULATED ACUTRAK 2 HT-1120
|
Facility
|
IP
|
$3,086.00
|
|
| Hospital Charge Code |
3901368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,572.63 |
| Max. Negotiated Rate |
$2,952.68 |
| Rate for Payer: Aetna Commercial |
$2,888.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,760.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,701.00
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,952.68
|
| Rate for Payer: Health EOS Commercial |
$2,856.40
|
| Rate for Payer: HFN Commercial |
$2,952.68
|
| Rate for Payer: Multiplan Commercial |
$2,567.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,952.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,572.63
|
| Rate for Payer: Quartz Commercial |
$1,925.66
|
| Rate for Payer: WEA Trust Commercial |
$1,765.19
|
| Rate for Payer: WPS Commercial |
$2,377.15
|
|
|
DROP DOWN PLUG STEM 5950-67
|
Facility
|
OP
|
$6,407.00
|
|
| Hospital Charge Code |
2967782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,865.72 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,865.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,331.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,331.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,198.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,728.87
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,997.46
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: NAPHCARE Commercial |
$3,997.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$4,331.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,997.97
|
| Rate for Payer: The Alliance Commercial |
$3,331.64
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
DROP DOWN PLUG STEM 5950-67
|
Facility
|
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2967782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,265.01 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$3,997.97
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$3,858.06
|
|
|
Service Code
|
APR-DRG 7702
|
| Min. Negotiated Rate |
$3,426.97 |
| Max. Negotiated Rate |
$3,858.06 |
| Rate for Payer: Anthem Medicaid |
$3,694.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,694.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,694.30
|
| Rate for Payer: Dean Health Medicaid |
$3,694.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,426.97
|
| Rate for Payer: Managed Health Services Medicaid |
$3,858.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,694.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,694.30
|
| Rate for Payer: United Healthcare Medicaid |
$3,694.30
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 7703
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$14,116.98
|
|
|
Service Code
|
APR-DRG 7704
|
| Min. Negotiated Rate |
$12,539.58 |
| Max. Negotiated Rate |
$14,116.98 |
| Rate for Payer: Anthem Medicaid |
$13,517.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,517.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,517.79
|
| Rate for Payer: Dean Health Medicaid |
$13,517.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,539.58
|
| Rate for Payer: Managed Health Services Medicaid |
$14,116.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,517.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,517.79
|
| Rate for Payer: United Healthcare Medicaid |
$13,517.79
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$2,455.13
|
|
|
Service Code
|
APR-DRG 7701
|
| Min. Negotiated Rate |
$2,180.80 |
| Max. Negotiated Rate |
$2,455.13 |
| Rate for Payer: Anthem Medicaid |
$2,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,350.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,350.92
|
| Rate for Payer: Dean Health Medicaid |
$2,350.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,180.80
|
| Rate for Payer: Managed Health Services Medicaid |
$2,455.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,350.92
|
| Rate for Payer: United Healthcare Medicaid |
$2,350.92
|
|
|
Drug Challenge During Cath
|
Facility
|
IP
|
$2,158.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
4510689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,099.72 |
| Max. Negotiated Rate |
$2,064.77 |
| Rate for Payer: Aetna Commercial |
$2,019.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,930.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,189.49
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$2,064.77
|
| Rate for Payer: Health EOS Commercial |
$1,997.44
|
| Rate for Payer: HFN Commercial |
$2,064.77
|
| Rate for Payer: Multiplan Commercial |
$1,795.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,064.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,099.72
|
| Rate for Payer: Quartz Commercial |
$1,346.59
|
| Rate for Payer: WEA Trust Commercial |
$1,234.38
|
| Rate for Payer: WPS Commercial |
$1,662.31
|
|
|
Drug Challenge During Cath
|
Facility
|
OP
|
$2,158.00
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
4510689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$328.85 |
| Max. Negotiated Rate |
$2,064.77 |
| Rate for Payer: Aetna Commercial |
$2,019.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,930.12
|
| Rate for Payer: Aetna Managed Medicare |
$628.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,458.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,122.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,077.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,189.49
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cigna Commercial |
$2,064.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,255.96
|
| Rate for Payer: Health EOS Commercial |
$1,997.44
|
| Rate for Payer: HFN Commercial |
$2,064.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,683.24
|
| Rate for Payer: Multiplan Commercial |
$1,795.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,346.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,064.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,099.72
|
| Rate for Payer: Quartz Commercial |
$1,458.81
|
| Rate for Payer: Quartz Medicare Advantage |
$1,346.59
|
| Rate for Payer: The Alliance Commercial |
$328.85
|
| Rate for Payer: WEA Trust Commercial |
$1,234.38
|
| Rate for Payer: WPS Commercial |
$1,662.31
|
|
|
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 |
$3,586.06 |
| Max. Negotiated Rate |
$6,733.00 |
| Rate for Payer: Aetna Commercial |
$6,586.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.79
|
| Rate for Payer: Cash Price |
$2,111.10
|
| Rate for Payer: Cigna Commercial |
$6,733.00
|
| Rate for Payer: Health EOS Commercial |
$6,513.45
|
| Rate for Payer: HFN Commercial |
$6,733.00
|
| Rate for Payer: Multiplan Commercial |
$5,854.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,733.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,586.06
|
| Rate for Payer: Quartz Commercial |
$4,391.09
|
| Rate for Payer: WEA Trust Commercial |
$4,025.16
|
| Rate for Payer: WPS Commercial |
$5,420.60
|
|
|
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 |
$2,049.17 |
| Max. Negotiated Rate |
$6,733.00 |
| Rate for Payer: Aetna Commercial |
$6,586.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.89
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,757.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.79
|
| Rate for Payer: Cash Price |
$2,111.10
|
| Rate for Payer: Cigna Commercial |
$6,733.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.53
|
| Rate for Payer: Health EOS Commercial |
$6,513.45
|
| Rate for Payer: HFN Commercial |
$6,733.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.86
|
| Rate for Payer: Multiplan Commercial |
$5,854.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,391.09
|
| Rate for Payer: Preferred Network Access Commercial |
$6,733.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,586.06
|
| Rate for Payer: Quartz Commercial |
$4,757.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,391.09
|
| Rate for Payer: The Alliance Commercial |
$3,659.24
|
| Rate for Payer: WEA Trust Commercial |
$4,025.16
|
| Rate for Payer: WPS Commercial |
$5,420.60
|
|
|
Drug Screen Panel 7, Serum
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Drug Screen Panel 7, Serum
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| 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 |
$127.33
|
| 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 |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| 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 |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| 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 |
$180.18
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Drug Screen Panel 7, Serum
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
1124800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| 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 |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| 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 |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| 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 |
$132.13
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Screen Panel 8, Serum
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$302.33 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| 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 |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$302.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$289.60
|
| Rate for Payer: HFN Commercial |
$302.33
|
| 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 |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$302.33
|
| Rate for Payer: Quartz Beloit One Network |
$140.03
|
| Rate for Payer: Quartz Commercial |
$181.40
|
| 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 |
$175.03
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Screen Panel 8, Serum
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| 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 |
$168.67
|
| 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 |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| 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 |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$206.86
|
| 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 |
$238.68
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Drug Screen Panel 8, Serum
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5158606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$190.94
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Drug Screen Panel 9, Meconium
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5290651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| 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 |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| 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 |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$207.53
|
| 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 |
$239.46
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
Drug Screen Panel 9, Meconium
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5290651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
Drug Screen Panel 9, Meconium
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5290651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$303.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$303.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$290.54
|
| Rate for Payer: HFN Commercial |
$303.32
|
| 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 |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$303.32
|
| Rate for Payer: Quartz Beloit One Network |
$140.48
|
| Rate for Payer: Quartz Commercial |
$181.99
|
| 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 |
$175.60
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Drug Scrn, Qual, Mult Drugs POC
|
Professional
|
Both
|
$28.00
|
|
| Hospital Charge Code |
1188805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$27.66 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.47
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: The Alliance Commercial |
$14.56
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Drug Toxicology Amphetamines, Saliva
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170646
|
|
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 Amphetamines, Saliva
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170646
|
|
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 Amphetamines, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170646
|
|
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 Barbiturates, Saliva
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5170647
|
|
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
|
|
