|
von Hippel-Lindau Sequencing
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$493.92 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$604.80
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$604.80
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
von Hippel-Lindau Sequencing
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.83 |
| Max. Negotiated Rate |
$1,099.32 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Aetna Managed Medicare |
$274.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$480.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.22
|
| Rate for Payer: Anthem Medicaid |
$274.83
|
| Rate for Payer: Anthem Medicare Advantage |
$274.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$274.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$274.83
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$274.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$564.08
|
| Rate for Payer: Dean Health Medicaid |
$274.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$274.83
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,022.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$274.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$274.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$274.83
|
| Rate for Payer: Managed Health Services Medicaid |
$285.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$274.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$274.83
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$412.24
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$274.83
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$655.20
|
| Rate for Payer: Quartz Medicare Advantage |
$274.83
|
| Rate for Payer: The Alliance Commercial |
$1,099.32
|
| Rate for Payer: United Healthcare Medicaid |
$274.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.83
|
| Rate for Payer: United Healthcare PPO |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: Wellcare Medicare |
$274.83
|
| Rate for Payer: WMAP Medicaid |
$274.83
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
von Hippel-Lindau Sequencing
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
CPT 81404
|
| Hospital Charge Code |
4526743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$443.52 |
| Max. Negotiated Rate |
$970.15 |
| Rate for Payer: Aetna Commercial |
$957.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$957.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$604.80
|
| Rate for Payer: Health EOS Commercial |
$917.28
|
| Rate for Payer: HFN Commercial |
$957.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.15
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$957.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.52
|
| Rate for Payer: Quartz Commercial |
$574.56
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
von Willebrand Comprehensive Panel
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.20
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: HFN Commercial |
$144.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
von Willebrand Comprehensive Panel
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
von Willebrand Comprehensive Panel
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicaid |
$6.21
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Dean Health Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.21
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WMAP Medicaid |
$6.21
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Von Willebrand Factor Antigen
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
978096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: The Alliance Commercial |
$364.50
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
| Rate for Payer: Aetna Commercial |
$692.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$692.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.40
|
| Rate for Payer: Health EOS Commercial |
$663.39
|
| Rate for Payer: HFN Commercial |
$692.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$692.55
|
| Rate for Payer: Quartz Beloit One Network |
$320.76
|
| Rate for Payer: Quartz Commercial |
$415.53
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
978096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.08
|
| Rate for Payer: Anthem Medicaid |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.94
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.95
|
| Rate for Payer: Dean Health Medicaid |
$23.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.94
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.94
|
| Rate for Payer: Managed Health Services Medicaid |
$24.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$34.41
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.70
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$473.85
|
| Rate for Payer: Quartz Medicare Advantage |
$22.94
|
| Rate for Payer: The Alliance Commercial |
$91.76
|
| Rate for Payer: United Healthcare Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare PPO |
$546.75
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: Wellcare Medicare |
$22.94
|
| Rate for Payer: WMAP Medicaid |
$23.70
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2943027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$683.56 |
| Rate for Payer: Aetna Commercial |
$668.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.98
|
| Rate for Payer: Aetna Managed Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.08
|
| Rate for Payer: Anthem Medicaid |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.94
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$683.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.78
|
| Rate for Payer: Dean Health Medicaid |
$23.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.94
|
| Rate for Payer: Health EOS Commercial |
$661.27
|
| Rate for Payer: HFN Commercial |
$683.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.94
|
| Rate for Payer: Managed Health Services Medicaid |
$24.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.41
|
| Rate for Payer: Preferred Network Access Commercial |
$683.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.70
|
| Rate for Payer: Quartz Beloit One Network |
$364.07
|
| Rate for Payer: Quartz Commercial |
$482.95
|
| Rate for Payer: Quartz Medicare Advantage |
$22.94
|
| Rate for Payer: The Alliance Commercial |
$91.76
|
| Rate for Payer: United Healthcare Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare PPO |
$557.25
|
| Rate for Payer: WEA Trust Commercial |
$408.65
|
| Rate for Payer: Wellcare Medicare |
$22.94
|
| Rate for Payer: WMAP Medicaid |
$23.70
|
| Rate for Payer: WPS Commercial |
$550.34
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2943027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$364.07 |
| Max. Negotiated Rate |
$683.56 |
| Rate for Payer: Aetna Commercial |
$668.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.79
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$683.56
|
| Rate for Payer: Health EOS Commercial |
$661.27
|
| Rate for Payer: HFN Commercial |
$683.56
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: NAPHCARE Commercial |
$445.80
|
| Rate for Payer: Preferred Network Access Commercial |
$683.56
|
| Rate for Payer: Quartz Beloit One Network |
$364.07
|
| Rate for Payer: Quartz Commercial |
$445.80
|
| Rate for Payer: WEA Trust Commercial |
$408.65
|
| Rate for Payer: WPS Commercial |
$550.34
|
|
|
Von Willebrand Factor Antigen
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2943027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna Commercial |
$705.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.98
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$705.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.80
|
| Rate for Payer: Health EOS Commercial |
$676.13
|
| Rate for Payer: HFN Commercial |
$705.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$705.85
|
| Rate for Payer: Quartz Beloit One Network |
$326.92
|
| Rate for Payer: Quartz Commercial |
$423.51
|
| Rate for Payer: The Alliance Commercial |
$371.50
|
| Rate for Payer: WEA Trust Commercial |
$408.65
|
| Rate for Payer: WPS Commercial |
$550.34
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
978096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$357.21 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$437.40
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$437.40
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
Von Willebrand Factor Multimer Assay
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2943028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$784.70 |
| Rate for Payer: Aetna Commercial |
$784.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.36
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$784.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$413.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.60
|
| Rate for Payer: Health EOS Commercial |
$751.66
|
| Rate for Payer: HFN Commercial |
$784.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.70
|
| Rate for Payer: Quartz Beloit One Network |
$363.44
|
| Rate for Payer: Quartz Commercial |
$470.82
|
| Rate for Payer: The Alliance Commercial |
$413.00
|
| Rate for Payer: WEA Trust Commercial |
$454.30
|
| Rate for Payer: WPS Commercial |
$611.82
|
|
|
Von Willebrand Factor Multimer Assay
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
978097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Aetna Commercial |
$741.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$741.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.60
|
| Rate for Payer: Health EOS Commercial |
$710.71
|
| Rate for Payer: HFN Commercial |
$741.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$741.95
|
| Rate for Payer: Quartz Beloit One Network |
$343.64
|
| Rate for Payer: Quartz Commercial |
$445.17
|
| Rate for Payer: The Alliance Commercial |
$390.50
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
978097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.08
|
| Rate for Payer: Anthem Medicaid |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.94
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.05
|
| Rate for Payer: Dean Health Medicaid |
$23.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.94
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.94
|
| Rate for Payer: Managed Health Services Medicaid |
$24.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$34.41
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.70
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$507.65
|
| Rate for Payer: Quartz Medicare Advantage |
$22.94
|
| Rate for Payer: The Alliance Commercial |
$91.76
|
| Rate for Payer: United Healthcare Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare PPO |
$585.75
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: Wellcare Medicare |
$22.94
|
| Rate for Payer: WMAP Medicaid |
$23.70
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2943028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$759.92 |
| Rate for Payer: Aetna Commercial |
$743.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.36
|
| Rate for Payer: Aetna Managed Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.08
|
| Rate for Payer: Anthem Medicaid |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$437.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.94
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$759.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.23
|
| Rate for Payer: Dean Health Medicaid |
$23.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.94
|
| Rate for Payer: Health EOS Commercial |
$735.14
|
| Rate for Payer: HFN Commercial |
$759.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.94
|
| Rate for Payer: Managed Health Services Medicaid |
$24.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: NAPHCARE Commercial |
$34.41
|
| Rate for Payer: Preferred Network Access Commercial |
$759.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.70
|
| Rate for Payer: Quartz Beloit One Network |
$404.74
|
| Rate for Payer: Quartz Commercial |
$536.90
|
| Rate for Payer: Quartz Medicare Advantage |
$22.94
|
| Rate for Payer: The Alliance Commercial |
$91.76
|
| Rate for Payer: United Healthcare Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare PPO |
$619.50
|
| Rate for Payer: WEA Trust Commercial |
$454.30
|
| Rate for Payer: Wellcare Medicare |
$22.94
|
| Rate for Payer: WMAP Medicaid |
$23.70
|
| Rate for Payer: WPS Commercial |
$611.82
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
978097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$382.69 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$468.60
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$468.60
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2943028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$404.74 |
| Max. Negotiated Rate |
$759.92 |
| Rate for Payer: Aetna Commercial |
$743.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$437.78
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$759.92
|
| Rate for Payer: Health EOS Commercial |
$735.14
|
| Rate for Payer: HFN Commercial |
$759.92
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: NAPHCARE Commercial |
$495.60
|
| Rate for Payer: Preferred Network Access Commercial |
$759.92
|
| Rate for Payer: Quartz Beloit One Network |
$404.74
|
| Rate for Payer: Quartz Commercial |
$495.60
|
| Rate for Payer: WEA Trust Commercial |
$454.30
|
| Rate for Payer: WPS Commercial |
$611.82
|
|
|
Von Willebrand Factor Ristocetin Cofactor
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2943029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Aetna Managed Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.08
|
| Rate for Payer: Anthem Medicaid |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.94
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.47
|
| Rate for Payer: Dean Health Medicaid |
$23.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.94
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.94
|
| Rate for Payer: Managed Health Services Medicaid |
$24.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$34.41
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.70
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$217.75
|
| Rate for Payer: Quartz Medicare Advantage |
$22.94
|
| Rate for Payer: The Alliance Commercial |
$91.76
|
| Rate for Payer: United Healthcare Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare PPO |
$251.25
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: Wellcare Medicare |
$22.94
|
| Rate for Payer: WMAP Medicaid |
$23.70
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
Von Willebrand Factor Ristocetin Cofactor
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2943029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
Von Willebrand Factor Ristocetin Cofactor
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2943029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$318.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$318.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.00
|
| Rate for Payer: Health EOS Commercial |
$304.85
|
| Rate for Payer: HFN Commercial |
$318.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$318.25
|
| Rate for Payer: Quartz Beloit One Network |
$147.40
|
| Rate for Payer: Quartz Commercial |
$190.95
|
| Rate for Payer: The Alliance Commercial |
$167.50
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
Voriconazole Level, HPLC
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
Voriconazole Level, HPLC
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$317.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.40
|
| Rate for Payer: Health EOS Commercial |
$303.94
|
| Rate for Payer: HFN Commercial |
$317.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$317.30
|
| Rate for Payer: Quartz Beloit One Network |
$146.96
|
| Rate for Payer: Quartz Commercial |
$190.38
|
| Rate for Payer: The Alliance Commercial |
$167.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
Voriconazole Level, HPLC
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
Voyager 2.0mm x 8mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$1,808.80 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$952.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,142.40
|
| Rate for Payer: Health EOS Commercial |
$1,732.64
|
| Rate for Payer: HFN Commercial |
$1,808.80
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,808.80
|
| Rate for Payer: Quartz Beloit One Network |
$837.76
|
| Rate for Payer: Quartz Commercial |
$1,085.28
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
