|
Mayo, Copper Liver Ts
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
4860606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.81
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Mayo, Cytogenetics DNA
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4574683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Mayo, Cytogenetics DNA
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4574683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Mayo, Epstein-Barr ISH
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$804.65 |
| Rate for Payer: Aetna Commercial |
$804.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.42
|
| Rate for Payer: Anthem Commercial |
$39.89
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$804.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$423.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.20
|
| Rate for Payer: Health EOS Commercial |
$770.77
|
| Rate for Payer: HFN Commercial |
$804.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$621.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$621.53
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Preferred Network Access Commercial |
$804.65
|
| Rate for Payer: Quartz Beloit One Network |
$372.68
|
| Rate for Payer: Quartz Commercial |
$482.79
|
| Rate for Payer: The Alliance Commercial |
$423.50
|
| Rate for Payer: WEA Trust Commercial |
$465.85
|
| Rate for Payer: WPS Commercial |
$627.37
|
|
|
Mayo, Epstein-Barr ISH
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$779.24 |
| Rate for Payer: Aetna Commercial |
$762.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.42
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$779.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$753.83
|
| Rate for Payer: HFN Commercial |
$779.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$779.24
|
| Rate for Payer: Quartz Beloit One Network |
$415.03
|
| Rate for Payer: Quartz Commercial |
$550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$635.25
|
| Rate for Payer: WEA Trust Commercial |
$465.85
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$627.37
|
|
|
Mayo, Epstein-Barr ISH
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$415.03 |
| Max. Negotiated Rate |
$779.24 |
| Rate for Payer: Aetna Commercial |
$762.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.91
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$779.24
|
| Rate for Payer: Health EOS Commercial |
$753.83
|
| Rate for Payer: HFN Commercial |
$779.24
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: NAPHCARE Commercial |
$508.20
|
| Rate for Payer: Preferred Network Access Commercial |
$779.24
|
| Rate for Payer: Quartz Beloit One Network |
$415.03
|
| Rate for Payer: Quartz Commercial |
$508.20
|
| Rate for Payer: WEA Trust Commercial |
$465.85
|
| Rate for Payer: WPS Commercial |
$627.37
|
|
|
Mayo, HPV Low Risk ISH
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$1,005.56 |
| Rate for Payer: Aetna Commercial |
$983.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.98
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cigna Commercial |
$1,005.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$972.77
|
| Rate for Payer: HFN Commercial |
$1,005.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.56
|
| Rate for Payer: Quartz Beloit One Network |
$535.57
|
| Rate for Payer: Quartz Commercial |
$710.45
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$819.75
|
| Rate for Payer: WEA Trust Commercial |
$601.15
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
Mayo, HPV Low Risk ISH
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$535.57 |
| Max. Negotiated Rate |
$1,005.56 |
| Rate for Payer: Aetna Commercial |
$983.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.29
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cigna Commercial |
$1,005.56
|
| Rate for Payer: Health EOS Commercial |
$972.77
|
| Rate for Payer: HFN Commercial |
$1,005.56
|
| Rate for Payer: Multiplan Commercial |
$874.40
|
| Rate for Payer: NAPHCARE Commercial |
$655.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.56
|
| Rate for Payer: Quartz Beloit One Network |
$535.57
|
| Rate for Payer: Quartz Commercial |
$655.80
|
| Rate for Payer: WEA Trust Commercial |
$601.15
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
Mayo, IF Ab Stain
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4605740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Mayo, IF Ab Stain
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4605740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$624.00
|
| Rate for Payer: United Healthcare PPO |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Mayo, IF Ab Stain
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4605740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$370.44 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Anthem Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.60
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Mayo, IF Renal
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
4574691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$138.46
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$148.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$143.29
|
| Rate for Payer: HFN Commercial |
$148.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$148.12
|
| Rate for Payer: Quartz Beloit One Network |
$78.89
|
| Rate for Payer: Quartz Commercial |
$104.65
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$120.75
|
| Rate for Payer: WEA Trust Commercial |
$88.55
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$119.25
|
|
|
Mayo, IF Renal
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
4574691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$148.12 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.33
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$148.12
|
| Rate for Payer: Health EOS Commercial |
$143.29
|
| Rate for Payer: HFN Commercial |
$148.12
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: NAPHCARE Commercial |
$96.60
|
| Rate for Payer: Preferred Network Access Commercial |
$148.12
|
| Rate for Payer: Quartz Beloit One Network |
$78.89
|
| Rate for Payer: Quartz Commercial |
$96.60
|
| Rate for Payer: WEA Trust Commercial |
$88.55
|
| Rate for Payer: WPS Commercial |
$119.25
|
|
|
Mayo, IGH Amp Meth
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 81261
|
| Hospital Charge Code |
4588657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$166.80
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Mayo, IGH Amp Meth
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 81261
|
| Hospital Charge Code |
4588657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$791.96 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Aetna Managed Medicare |
$197.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$742.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.66
|
| Rate for Payer: Anthem Medicaid |
$204.58
|
| Rate for Payer: Anthem Medicare Advantage |
$197.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.99
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.57
|
| Rate for Payer: Dean Health Medicaid |
$204.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.99
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$204.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.99
|
| Rate for Payer: Managed Health Services Medicaid |
$212.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.99
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.98
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$204.58
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$180.70
|
| Rate for Payer: Quartz Medicare Advantage |
$197.99
|
| Rate for Payer: The Alliance Commercial |
$791.96
|
| Rate for Payer: United Healthcare Medicaid |
$204.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.99
|
| Rate for Payer: United Healthcare PPO |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: Wellcare Medicare |
$197.99
|
| Rate for Payer: WMAP Medicaid |
$204.58
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Mayo, IGH Clonal Pop
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 81264
|
| Hospital Charge Code |
4588658
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$172.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$302.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.73
|
| Rate for Payer: Anthem Medicaid |
$162.98
|
| Rate for Payer: Anthem Medicare Advantage |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$172.73
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$172.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Dean Health Medicaid |
$162.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$172.73
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$162.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$172.73
|
| Rate for Payer: Managed Health Services Medicaid |
$169.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$172.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$172.73
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$259.10
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$162.98
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$172.73
|
| Rate for Payer: The Alliance Commercial |
$690.92
|
| Rate for Payer: United Healthcare Medicaid |
$162.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.73
|
| Rate for Payer: United Healthcare PPO |
$157.50
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: Wellcare Medicare |
$172.73
|
| Rate for Payer: WMAP Medicaid |
$162.98
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Mayo, IGH Clonal Pop
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 81264
|
| Hospital Charge Code |
4588658
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Mayo, Initial Stain
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
4574690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$312.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.42
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$319.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$308.83
|
| Rate for Payer: HFN Commercial |
$319.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$319.24
|
| Rate for Payer: Quartz Beloit One Network |
$170.03
|
| Rate for Payer: Quartz Commercial |
$225.55
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$260.25
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
Mayo, Initial Stain
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
4574690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.03 |
| Max. Negotiated Rate |
$319.24 |
| Rate for Payer: Aetna Commercial |
$312.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.91
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$319.24
|
| Rate for Payer: Health EOS Commercial |
$308.83
|
| Rate for Payer: HFN Commercial |
$319.24
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: NAPHCARE Commercial |
$208.20
|
| Rate for Payer: Preferred Network Access Commercial |
$319.24
|
| Rate for Payer: Quartz Beloit One Network |
$170.03
|
| Rate for Payer: Quartz Commercial |
$208.20
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
Mayo, Interphases 100-300
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4574684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Mayo, Interphases 100-300
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4574684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.98
|
| Rate for Payer: Anthem Medicaid |
$52.89
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Dean Health Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$52.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Managed Health Services Medicaid |
$55.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$76.78
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52.89
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$204.76
|
| Rate for Payer: United Healthcare Medicaid |
$52.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare PPO |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: Wellcare Medicare |
$51.19
|
| Rate for Payer: WMAP Medicaid |
$52.89
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Mayo, Interphases 25-99
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
4605739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.60
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Mayo, Interphases 25-99
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
4605739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$169.52 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.35
|
| Rate for Payer: Anthem Medicaid |
$43.79
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Dean Health Medicaid |
$43.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$43.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Managed Health Services Medicaid |
$45.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$43.79
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$169.52
|
| Rate for Payer: United Healthcare Medicaid |
$43.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: United Healthcare PPO |
$50.25
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$42.38
|
| Rate for Payer: WMAP Medicaid |
$43.79
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Mayo, Interphases 25-99
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
4605739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Mayo, Kappa & Lambda FISH
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
4574693
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
