|
FACET INJECTION
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2960044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
FACET INJECTION
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2960044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
FACIAL SKELETAL SURGERY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
FACIAL SKELETAL SURGERY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
FACIAL WRAP UNIVERSAL 2020
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
4132073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.04 |
| Max. Negotiated Rate |
$1,072.00 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Aetna Managed Medicare |
$75.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$246.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.97
|
| Rate for Payer: Health EOS Commercial |
$238.52
|
| Rate for Payer: HFN Commercial |
$246.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: NAPHCARE Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$246.56
|
| Rate for Payer: Quartz Beloit One Network |
$131.32
|
| Rate for Payer: Quartz Commercial |
$174.20
|
| Rate for Payer: Quartz Medicare Advantage |
$160.80
|
| Rate for Payer: The Alliance Commercial |
$1,072.00
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
FACIAL WRAP UNIVERSAL 2020
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
4132073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$246.56 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$246.56
|
| Rate for Payer: Health EOS Commercial |
$238.52
|
| Rate for Payer: HFN Commercial |
$246.56
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: NAPHCARE Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$246.56
|
| Rate for Payer: Quartz Beloit One Network |
$131.32
|
| Rate for Payer: Quartz Commercial |
$160.80
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
Factor II Activity, Clotting
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
5438905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$213.44 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$139.20
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Factor II Activity, Clotting
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
5438905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$220.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.20
|
| Rate for Payer: Health EOS Commercial |
$211.12
|
| Rate for Payer: HFN Commercial |
$220.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.82
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$220.40
|
| Rate for Payer: Quartz Beloit One Network |
$102.08
|
| Rate for Payer: Quartz Commercial |
$132.24
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Factor II Activity, Clotting
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
5438905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$213.44 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Aetna Managed Medicare |
$12.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.55
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.98
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.83
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.98
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.98
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.98
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.47
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$150.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12.98
|
| Rate for Payer: The Alliance Commercial |
$51.92
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.98
|
| Rate for Payer: United Healthcare PPO |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: Wellcare Medicare |
$12.98
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Factor IX Assay
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
977940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$363.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.80
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| Rate for Payer: HFN Commercial |
$363.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.21
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Preferred Network Access Commercial |
$363.85
|
| Rate for Payer: Quartz Beloit One Network |
$168.52
|
| Rate for Payer: Quartz Commercial |
$218.31
|
| Rate for Payer: The Alliance Commercial |
$191.50
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
Factor IX Assay
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
977940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.67 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$229.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$229.80
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
Factor IX Assay
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
977940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$19.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.61
|
| Rate for Payer: Anthem Medicaid |
$19.67
|
| Rate for Payer: Anthem Medicare Advantage |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.04
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.33
|
| Rate for Payer: Dean Health Medicaid |
$19.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.04
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.04
|
| Rate for Payer: Managed Health Services Medicaid |
$20.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.04
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.56
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.67
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$248.95
|
| Rate for Payer: Quartz Medicare Advantage |
$19.04
|
| Rate for Payer: The Alliance Commercial |
$76.16
|
| Rate for Payer: United Healthcare Medicaid |
$19.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.04
|
| Rate for Payer: United Healthcare PPO |
$287.25
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: Wellcare Medicare |
$19.04
|
| Rate for Payer: WMAP Medicaid |
$19.67
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
Factor V Assay
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
977941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$211.80
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$211.80
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Factor V Assay
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
977941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$335.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.80
|
| Rate for Payer: Health EOS Commercial |
$321.23
|
| Rate for Payer: HFN Commercial |
$335.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.30
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Preferred Network Access Commercial |
$335.35
|
| Rate for Payer: Quartz Beloit One Network |
$155.32
|
| Rate for Payer: Quartz Commercial |
$201.21
|
| Rate for Payer: The Alliance Commercial |
$176.50
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Factor V Assay
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
977941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Aetna Managed Medicare |
$17.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.30
|
| Rate for Payer: Anthem Medicaid |
$18.24
|
| Rate for Payer: Anthem Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.65
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.54
|
| Rate for Payer: Dean Health Medicaid |
$18.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.65
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.65
|
| Rate for Payer: Managed Health Services Medicaid |
$18.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.65
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$26.48
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.24
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$229.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.65
|
| Rate for Payer: The Alliance Commercial |
$70.60
|
| Rate for Payer: United Healthcare Medicaid |
$18.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.65
|
| Rate for Payer: United Healthcare PPO |
$264.75
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: Wellcare Medicare |
$17.65
|
| Rate for Payer: WMAP Medicaid |
$18.24
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
.Factor V Hr2 Mutat Anal
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
6230785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$255.84 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$63.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.17
|
| Rate for Payer: Anthem Medicaid |
$63.96
|
| Rate for Payer: Anthem Medicare Advantage |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.96
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$63.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Dean Health Medicaid |
$63.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$63.96
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.96
|
| Rate for Payer: Managed Health Services Medicaid |
$66.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$63.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$95.94
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.96
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$63.96
|
| Rate for Payer: The Alliance Commercial |
$255.84
|
| Rate for Payer: United Healthcare Medicaid |
$63.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.96
|
| Rate for Payer: United Healthcare PPO |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$63.96
|
| Rate for Payer: WMAP Medicaid |
$63.96
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
.Factor V Hr2 Mutat Anal
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
6230785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.00
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.78
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
.Factor V Hr2 Mutat Anal
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
6230785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
Factor VII Activity, Clotting
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3256227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$103.80
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Factor VII Activity, Clotting
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3256227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna Commercial |
$164.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$164.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.80
|
| Rate for Payer: Health EOS Commercial |
$157.43
|
| Rate for Payer: HFN Commercial |
$164.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.19
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.35
|
| Rate for Payer: Quartz Beloit One Network |
$76.12
|
| Rate for Payer: Quartz Commercial |
$98.61
|
| Rate for Payer: The Alliance Commercial |
$86.50
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Factor VII Activity, Clotting
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
3256227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.71
|
| Rate for Payer: Anthem Medicaid |
$18.50
|
| Rate for Payer: Anthem Medicare Advantage |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.81
|
| Rate for Payer: Dean Health Medicaid |
$18.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.90
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.90
|
| Rate for Payer: Managed Health Services Medicaid |
$19.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$26.85
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.50
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$112.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.90
|
| Rate for Payer: The Alliance Commercial |
$71.60
|
| Rate for Payer: United Healthcare Medicaid |
$18.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.90
|
| Rate for Payer: United Healthcare PPO |
$129.75
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: Wellcare Medicare |
$17.90
|
| Rate for Payer: WMAP Medicaid |
$18.50
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Factor VIII Antigen
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 85244
|
| Hospital Charge Code |
4526697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Factor VIII Antigen
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
CPT 85244
|
| Hospital Charge Code |
4526697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna Commercial |
$328.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$328.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.60
|
| Rate for Payer: Health EOS Commercial |
$314.86
|
| Rate for Payer: HFN Commercial |
$328.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$328.70
|
| Rate for Payer: Quartz Beloit One Network |
$152.24
|
| Rate for Payer: Quartz Commercial |
$197.22
|
| Rate for Payer: The Alliance Commercial |
$173.00
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Factor VIII Antigen
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 85244
|
| Hospital Charge Code |
4526697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$20.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.90
|
| Rate for Payer: Anthem Medicaid |
$21.10
|
| Rate for Payer: Anthem Medicare Advantage |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.42
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.62
|
| Rate for Payer: Dean Health Medicaid |
$21.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.42
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.63
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.10
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$20.42
|
| Rate for Payer: The Alliance Commercial |
$81.68
|
| Rate for Payer: United Healthcare Medicaid |
$21.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.42
|
| Rate for Payer: United Healthcare PPO |
$259.50
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: Wellcare Medicare |
$20.42
|
| Rate for Payer: WMAP Medicaid |
$21.10
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Factor VIII Assay
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
2943026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$918.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$483.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.20
|
| Rate for Payer: Health EOS Commercial |
$879.97
|
| Rate for Payer: HFN Commercial |
$918.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.19
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$918.65
|
| Rate for Payer: Quartz Beloit One Network |
$425.48
|
| Rate for Payer: Quartz Commercial |
$551.19
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
