|
von Willebrand Comprehensive Panel
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
von Willebrand Comprehensive Panel
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
von Willebrand Comprehensive Panel
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
983439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$150.18 |
| Rate for Payer: Aetna Commercial |
$150.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$150.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$143.85
|
| Rate for Payer: HFN Commercial |
$150.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$150.18
|
| Rate for Payer: Quartz Beloit One Network |
$69.56
|
| Rate for Payer: Quartz Commercial |
$90.11
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
978096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$371.50 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$454.90
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
978096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$492.80
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$95.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: United Healthcare PPO |
$568.62
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: Wellcare Medicare |
$23.86
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
Von Willebrand Factor Antigen
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2943027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$734.08 |
| Rate for Payer: Aetna Commercial |
$734.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$734.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$703.18
|
| Rate for Payer: HFN Commercial |
$734.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$734.08
|
| Rate for Payer: Quartz Beloit One Network |
$340.00
|
| Rate for Payer: Quartz Commercial |
$440.45
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: WPS Commercial |
$104.97
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2943027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$695.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$687.72
|
| Rate for Payer: HFN Commercial |
$710.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$710.90
|
| Rate for Payer: Quartz Beloit One Network |
$378.63
|
| Rate for Payer: Quartz Commercial |
$502.27
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$95.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: United Healthcare PPO |
$579.54
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: Wellcare Medicare |
$23.86
|
| Rate for Payer: WPS Commercial |
$572.33
|
|
|
Von Willebrand Factor Antigen
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
978096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$720.25 |
| Rate for Payer: Aetna Commercial |
$720.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$720.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$689.93
|
| Rate for Payer: HFN Commercial |
$720.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$720.25
|
| Rate for Payer: Quartz Beloit One Network |
$333.59
|
| Rate for Payer: Quartz Commercial |
$432.15
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$104.97
|
|
|
Von Willebrand Factor Antigen
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
2943027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$378.63 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$695.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.54
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: Health EOS Commercial |
$687.72
|
| Rate for Payer: HFN Commercial |
$710.90
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: Preferred Network Access Commercial |
$710.90
|
| Rate for Payer: Quartz Beloit One Network |
$378.63
|
| Rate for Payer: Quartz Commercial |
$463.63
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: WPS Commercial |
$572.33
|
|
|
Von Willebrand Factor Multimer Assay
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2943028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$816.09 |
| Rate for Payer: Aetna Commercial |
$816.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.77
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$816.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$429.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$781.73
|
| Rate for Payer: HFN Commercial |
$816.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$687.23
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$816.09
|
| Rate for Payer: Quartz Beloit One Network |
$377.98
|
| Rate for Payer: Quartz Commercial |
$489.65
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: WEA Trust Commercial |
$472.47
|
| Rate for Payer: WPS Commercial |
$104.97
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2943028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$420.93 |
| Max. Negotiated Rate |
$790.32 |
| Rate for Payer: Aetna Commercial |
$773.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.29
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$790.32
|
| Rate for Payer: Health EOS Commercial |
$764.55
|
| Rate for Payer: HFN Commercial |
$790.32
|
| Rate for Payer: Multiplan Commercial |
$687.23
|
| Rate for Payer: Preferred Network Access Commercial |
$790.32
|
| Rate for Payer: Quartz Beloit One Network |
$420.93
|
| Rate for Payer: Quartz Commercial |
$515.42
|
| Rate for Payer: WEA Trust Commercial |
$472.47
|
| Rate for Payer: WPS Commercial |
$636.27
|
|
|
Von Willebrand Factor Multimer Assay
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
978097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$771.63 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$771.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$739.14
|
| Rate for Payer: HFN Commercial |
$771.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$771.63
|
| Rate for Payer: Quartz Beloit One Network |
$357.39
|
| Rate for Payer: Quartz Commercial |
$462.98
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$104.97
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
2943028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$790.32 |
| Rate for Payer: Aetna Commercial |
$773.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.77
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$790.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$480.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$764.55
|
| Rate for Payer: HFN Commercial |
$790.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$687.23
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$790.32
|
| Rate for Payer: Quartz Beloit One Network |
$420.93
|
| Rate for Payer: Quartz Commercial |
$558.38
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$95.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: United Healthcare PPO |
$644.28
|
| Rate for Payer: WEA Trust Commercial |
$472.47
|
| Rate for Payer: Wellcare Medicare |
$23.86
|
| Rate for Payer: WPS Commercial |
$636.27
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
978097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$527.96
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$95.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: United Healthcare PPO |
$609.18
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: Wellcare Medicare |
$23.86
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
Von Willebrand Factor Multimer Assay
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
978097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$487.34
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
Von Willebrand Factor Ristocetin Cofactor
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2943029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$226.46
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$95.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: United Healthcare PPO |
$261.30
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: Wellcare Medicare |
$23.86
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
Von Willebrand Factor Ristocetin Cofactor
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2943029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
Von Willebrand Factor Ristocetin Cofactor
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
2943029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$330.98 |
| Rate for Payer: Aetna Commercial |
$330.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$330.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$317.04
|
| Rate for Payer: HFN Commercial |
$330.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$330.98
|
| Rate for Payer: Quartz Beloit One Network |
$153.30
|
| Rate for Payer: Quartz Commercial |
$198.59
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$104.97
|
|
|
Voriconazole Level, HPLC
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
Voriconazole Level, HPLC
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$329.99 |
| Rate for Payer: Aetna Commercial |
$329.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$329.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$316.10
|
| Rate for Payer: HFN Commercial |
$329.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$329.99
|
| Rate for Payer: Quartz Beloit One Network |
$152.84
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Voriconazole Level, HPLC
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
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 |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Voyager 2.0mm x 8mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Voyager 2.0mm x 8mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Voyager 2.5mm x 8mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
