|
FACIAL WRAP UNIVERSAL 2020
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
4132073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$167.23
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
FACIAL WRAP UNIVERSAL 2020
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
4132073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.04 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$78.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.98
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$167.23
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$181.17
|
| Rate for Payer: Quartz Medicare Advantage |
$167.23
|
| Rate for Payer: The Alliance Commercial |
$139.36
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Factor II Activity, Clotting
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
5438905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$221.98 |
| Rate for Payer: Aetna Commercial |
$217.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Managed Medicare |
$13.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.41
|
| Rate for Payer: Anthem Medicare Advantage |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.50
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$221.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.50
|
| Rate for Payer: Health EOS Commercial |
$214.74
|
| Rate for Payer: HFN Commercial |
$221.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: NAPHCARE Commercial |
$20.25
|
| Rate for Payer: Preferred Network Access Commercial |
$221.98
|
| Rate for Payer: Quartz Beloit One Network |
$118.23
|
| Rate for Payer: Quartz Commercial |
$156.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.50
|
| Rate for Payer: The Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.50
|
| Rate for Payer: United Healthcare PPO |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: Wellcare Medicare |
$13.50
|
| Rate for Payer: WPS Commercial |
$178.71
|
|
|
Factor II Activity, Clotting
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
5438905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$221.98 |
| Rate for Payer: Aetna Commercial |
$217.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.88
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$221.98
|
| Rate for Payer: Health EOS Commercial |
$214.74
|
| Rate for Payer: HFN Commercial |
$221.98
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: Preferred Network Access Commercial |
$221.98
|
| Rate for Payer: Quartz Beloit One Network |
$118.23
|
| Rate for Payer: Quartz Commercial |
$144.77
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$178.71
|
|
|
Factor II Activity, Clotting
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
5438905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$229.22 |
| Rate for Payer: Aetna Commercial |
$229.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Managed Medicare |
$13.50
|
| Rate for Payer: Anthem Medicare Advantage |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.50
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$229.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.50
|
| Rate for Payer: Health EOS Commercial |
$219.56
|
| Rate for Payer: HFN Commercial |
$229.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: NAPHCARE Commercial |
$20.25
|
| Rate for Payer: Preferred Network Access Commercial |
$229.22
|
| Rate for Payer: Quartz Beloit One Network |
$106.16
|
| Rate for Payer: Quartz Commercial |
$137.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.50
|
| Rate for Payer: The Alliance Commercial |
$53.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.50
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$59.40
|
|
|
Factor IX Assay
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
977940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$19.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.87
|
| Rate for Payer: Anthem Medicare Advantage |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.80
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.80
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$29.70
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$258.91
|
| Rate for Payer: Quartz Medicare Advantage |
$19.80
|
| Rate for Payer: The Alliance Commercial |
$79.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.80
|
| Rate for Payer: United Healthcare PPO |
$298.74
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: Wellcare Medicare |
$19.80
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
Factor IX Assay
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
977940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
Factor IX Assay
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
977940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$378.40 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.80
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.80
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.80
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$29.70
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$19.80
|
| Rate for Payer: The Alliance Commercial |
$78.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.80
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$87.13
|
|
|
Factor V Assay
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
977941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$337.75 |
| Rate for Payer: Aetna Commercial |
$330.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.57
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$337.75
|
| Rate for Payer: Health EOS Commercial |
$326.74
|
| Rate for Payer: HFN Commercial |
$337.75
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: Preferred Network Access Commercial |
$337.75
|
| Rate for Payer: Quartz Beloit One Network |
$179.89
|
| Rate for Payer: Quartz Commercial |
$220.27
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: WPS Commercial |
$271.92
|
|
|
Factor V Assay
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
977941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$348.76 |
| Rate for Payer: Aetna Commercial |
$348.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Aetna Managed Medicare |
$18.36
|
| Rate for Payer: Anthem Medicare Advantage |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.36
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$348.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.36
|
| Rate for Payer: Health EOS Commercial |
$334.08
|
| Rate for Payer: HFN Commercial |
$348.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: NAPHCARE Commercial |
$27.53
|
| Rate for Payer: Preferred Network Access Commercial |
$348.76
|
| Rate for Payer: Quartz Beloit One Network |
$161.53
|
| Rate for Payer: Quartz Commercial |
$209.26
|
| Rate for Payer: Quartz Medicare Advantage |
$18.36
|
| Rate for Payer: The Alliance Commercial |
$72.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.36
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: WPS Commercial |
$80.77
|
|
|
Factor V Assay
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
977941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$337.75 |
| Rate for Payer: Aetna Commercial |
$330.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Aetna Managed Medicare |
$18.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.47
|
| Rate for Payer: Anthem Medicare Advantage |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.36
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$337.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.36
|
| Rate for Payer: Health EOS Commercial |
$326.74
|
| Rate for Payer: HFN Commercial |
$337.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: NAPHCARE Commercial |
$27.53
|
| Rate for Payer: Preferred Network Access Commercial |
$337.75
|
| Rate for Payer: Quartz Beloit One Network |
$179.89
|
| Rate for Payer: Quartz Commercial |
$238.63
|
| Rate for Payer: Quartz Medicare Advantage |
$18.36
|
| Rate for Payer: The Alliance Commercial |
$73.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.36
|
| Rate for Payer: United Healthcare PPO |
$275.34
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: Wellcare Medicare |
$18.36
|
| Rate for Payer: WPS Commercial |
$271.92
|
|
|
.Factor V Hr2 Mutat Anal
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
6230785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$266.07 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$66.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.42
|
| Rate for Payer: Anthem Medicare Advantage |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.52
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66.52
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$99.78
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$66.52
|
| Rate for Payer: The Alliance Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare PPO |
$202.80
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: Wellcare Medicare |
$66.52
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
.Factor V Hr2 Mutat Anal
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
6230785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
.Factor V Hr2 Mutat Anal
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
6230785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$292.68 |
| Rate for Payer: Aetna Commercial |
$256.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$66.52
|
| Rate for Payer: Anthem Medicare Advantage |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.52
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$256.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.52
|
| Rate for Payer: Health EOS Commercial |
$246.06
|
| Rate for Payer: HFN Commercial |
$256.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$234.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$99.78
|
| Rate for Payer: Preferred Network Access Commercial |
$256.88
|
| Rate for Payer: Quartz Beloit One Network |
$118.98
|
| Rate for Payer: Quartz Commercial |
$154.13
|
| Rate for Payer: Quartz Medicare Advantage |
$66.52
|
| Rate for Payer: The Alliance Commercial |
$262.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$292.68
|
|
|
Factor VII Activity, Clotting
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3256227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Factor VII Activity, Clotting
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3256227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$18.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.90
|
| Rate for Payer: Anthem Medicare Advantage |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.62
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$27.92
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$18.62
|
| Rate for Payer: The Alliance Commercial |
$74.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.62
|
| Rate for Payer: United Healthcare PPO |
$134.94
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: Wellcare Medicare |
$18.62
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Factor VII Activity, Clotting
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3256227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$170.92 |
| Rate for Payer: Aetna Commercial |
$170.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$18.62
|
| Rate for Payer: Anthem Medicare Advantage |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.62
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$170.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$163.73
|
| Rate for Payer: HFN Commercial |
$170.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$27.92
|
| Rate for Payer: Preferred Network Access Commercial |
$170.92
|
| Rate for Payer: Quartz Beloit One Network |
$79.16
|
| Rate for Payer: Quartz Commercial |
$102.55
|
| Rate for Payer: Quartz Medicare Advantage |
$18.62
|
| Rate for Payer: The Alliance Commercial |
$73.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.62
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$81.91
|
|
|
Factor VIII Antigen
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
CPT 85244
|
| Hospital Charge Code |
4526697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$341.85 |
| Rate for Payer: Aetna Commercial |
$341.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$21.24
|
| Rate for Payer: Anthem Medicare Advantage |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.24
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$341.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.24
|
| Rate for Payer: Health EOS Commercial |
$327.45
|
| Rate for Payer: HFN Commercial |
$341.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$31.86
|
| Rate for Payer: Preferred Network Access Commercial |
$341.85
|
| Rate for Payer: Quartz Beloit One Network |
$158.33
|
| Rate for Payer: Quartz Commercial |
$205.11
|
| Rate for Payer: Quartz Medicare Advantage |
$21.24
|
| Rate for Payer: The Alliance Commercial |
$83.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.24
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$93.44
|
|
|
Factor VIII Antigen
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 85244
|
| Hospital Charge Code |
4526697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$215.90
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
Factor VIII Antigen
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 85244
|
| Hospital Charge Code |
4526697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$21.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.25
|
| Rate for Payer: Anthem Medicare Advantage |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.24
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.24
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$31.86
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$233.90
|
| Rate for Payer: Quartz Medicare Advantage |
$21.24
|
| Rate for Payer: The Alliance Commercial |
$84.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.24
|
| Rate for Payer: United Healthcare PPO |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: Wellcare Medicare |
$21.24
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
Factor VIII Assay
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
2943026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: Aetna Commercial |
$955.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.62
|
| Rate for Payer: Anthem Medicare Advantage |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$502.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$915.17
|
| Rate for Payer: HFN Commercial |
$955.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$27.92
|
| Rate for Payer: Preferred Network Access Commercial |
$955.40
|
| Rate for Payer: Quartz Beloit One Network |
$442.50
|
| Rate for Payer: Quartz Commercial |
$573.24
|
| Rate for Payer: Quartz Medicare Advantage |
$18.62
|
| Rate for Payer: The Alliance Commercial |
$73.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.62
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$81.91
|
|
|
Factor VIII Assay
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
2943026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$492.78 |
| Max. Negotiated Rate |
$925.23 |
| Rate for Payer: Aetna Commercial |
$905.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.01
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$925.23
|
| Rate for Payer: Health EOS Commercial |
$895.06
|
| Rate for Payer: HFN Commercial |
$925.23
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: Preferred Network Access Commercial |
$925.23
|
| Rate for Payer: Quartz Beloit One Network |
$492.78
|
| Rate for Payer: Quartz Commercial |
$603.41
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$744.88
|
|
|
Factor VIII Assay
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
977943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$906.09 |
| Rate for Payer: Aetna Commercial |
$886.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.90
|
| Rate for Payer: Anthem Medicare Advantage |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.62
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$906.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$876.54
|
| Rate for Payer: HFN Commercial |
$906.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$787.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.92
|
| Rate for Payer: Preferred Network Access Commercial |
$906.09
|
| Rate for Payer: Quartz Beloit One Network |
$482.59
|
| Rate for Payer: Quartz Commercial |
$640.17
|
| Rate for Payer: Quartz Medicare Advantage |
$18.62
|
| Rate for Payer: The Alliance Commercial |
$74.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.62
|
| Rate for Payer: United Healthcare PPO |
$738.66
|
| Rate for Payer: WEA Trust Commercial |
$541.68
|
| Rate for Payer: Wellcare Medicare |
$18.62
|
| Rate for Payer: WPS Commercial |
$729.47
|
|
|
Factor VIII Assay
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
977943
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$482.59 |
| Max. Negotiated Rate |
$906.09 |
| Rate for Payer: Aetna Commercial |
$886.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.99
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$906.09
|
| Rate for Payer: Health EOS Commercial |
$876.54
|
| Rate for Payer: HFN Commercial |
$906.09
|
| Rate for Payer: Multiplan Commercial |
$787.90
|
| Rate for Payer: Preferred Network Access Commercial |
$906.09
|
| Rate for Payer: Quartz Beloit One Network |
$482.59
|
| Rate for Payer: Quartz Commercial |
$590.93
|
| Rate for Payer: WEA Trust Commercial |
$541.68
|
| Rate for Payer: WPS Commercial |
$729.47
|
|
|
Factor VIII Assay
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
2943026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$925.23 |
| Rate for Payer: Aetna Commercial |
$905.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.90
|
| Rate for Payer: Anthem Medicare Advantage |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$925.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$895.06
|
| Rate for Payer: HFN Commercial |
$925.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.62
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$27.92
|
| Rate for Payer: Preferred Network Access Commercial |
$925.23
|
| Rate for Payer: Quartz Beloit One Network |
$492.78
|
| Rate for Payer: Quartz Commercial |
$653.69
|
| Rate for Payer: Quartz Medicare Advantage |
$18.62
|
| Rate for Payer: The Alliance Commercial |
$74.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.62
|
| Rate for Payer: United Healthcare PPO |
$754.26
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: Wellcare Medicare |
$18.62
|
| Rate for Payer: WPS Commercial |
$744.88
|
|
