|
Mayo, Kappa & Lambda FISH
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
4574693
|
|
Hospital Revenue Code
|
300
|
| 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: United Healthcare PPO |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
Mayo, Kappa & Lambda ISH
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
Mayo, Kappa & Lambda ISH
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| 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 |
$228.43
|
| 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 |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| 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 |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| 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 |
$323.25
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
Mayo, Renal Bx, Elect Micro
|
Facility
|
IP
|
$1,872.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
4574692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$917.28 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.16
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,722.24
|
| Rate for Payer: Health EOS Commercial |
$1,666.08
|
| Rate for Payer: HFN Commercial |
$1,722.24
|
| Rate for Payer: Multiplan Commercial |
$1,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.24
|
| Rate for Payer: Quartz Beloit One Network |
$917.28
|
| Rate for Payer: Quartz Commercial |
$1,123.20
|
| Rate for Payer: WEA Trust Commercial |
$1,029.60
|
| Rate for Payer: WPS Commercial |
$1,386.59
|
|
|
Mayo, Renal Bx, Elect Micro
|
Facility
|
OP
|
$1,872.00
|
|
|
Service Code
|
CPT 88348
|
| Hospital Charge Code |
4574692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$849.92 |
| Max. Negotiated Rate |
$3,399.68 |
| Rate for Payer: Aetna Commercial |
$1,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.92
|
| Rate for Payer: Aetna Managed Medicare |
$849.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,187.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,487.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,410.87
|
| Rate for Payer: Anthem Medicare Advantage |
$849.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$849.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$849.92
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,722.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$849.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,047.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$849.92
|
| Rate for Payer: Health EOS Commercial |
$1,666.08
|
| Rate for Payer: HFN Commercial |
$1,722.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,161.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$849.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$849.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$849.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$849.92
|
| Rate for Payer: Multiplan Commercial |
$1,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,274.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.24
|
| Rate for Payer: Quartz Beloit One Network |
$917.28
|
| Rate for Payer: Quartz Commercial |
$1,216.80
|
| Rate for Payer: Quartz Medicare Advantage |
$849.92
|
| Rate for Payer: The Alliance Commercial |
$3,399.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$849.92
|
| Rate for Payer: United Healthcare PPO |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,029.60
|
| Rate for Payer: Wellcare Medicare |
$849.92
|
| Rate for Payer: WPS Commercial |
$1,386.59
|
|
|
Mayo, Renal Path Level IV
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
4574685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: The Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$460.50
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
Mayo, Renal Path Level IV
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
4574685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
Mayo, Slide Review
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
4605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$680.90 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Anthem Commercial |
$42.04
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: HFN Commercial |
$228.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$680.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$680.90
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Mayo, Slide Review
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
4605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Mayo, Slide Review
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
4605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.30
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$144.00
|
| Rate for Payer: The Alliance Commercial |
$960.00
|
| Rate for Payer: United Healthcare PPO |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Mayo, Special Stain
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
4574686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.02 |
| Max. Negotiated Rate |
$274.16 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.94
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$274.16
|
| Rate for Payer: Health EOS Commercial |
$265.22
|
| Rate for Payer: HFN Commercial |
$274.16
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: NAPHCARE Commercial |
$178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$274.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.02
|
| Rate for Payer: Quartz Commercial |
$178.80
|
| Rate for Payer: WEA Trust Commercial |
$163.90
|
| Rate for Payer: WPS Commercial |
$220.73
|
|
|
Mayo, Special Stain
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
4574686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$274.16 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.28
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$274.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$265.22
|
| Rate for Payer: HFN Commercial |
$274.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$274.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.02
|
| Rate for Payer: Quartz Commercial |
$193.70
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: The Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$223.50
|
| Rate for Payer: WEA Trust Commercial |
$163.90
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WPS Commercial |
$220.73
|
|
|
Mayo, Special Stain (s)
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
4574687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna Commercial |
$270.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.86
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$276.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$267.89
|
| Rate for Payer: HFN Commercial |
$276.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$276.92
|
| Rate for Payer: Quartz Beloit One Network |
$147.49
|
| Rate for Payer: Quartz Commercial |
$195.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$225.75
|
| Rate for Payer: WEA Trust Commercial |
$165.55
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$222.95
|
|
|
Mayo, Special Stain (s)
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
4574687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.49 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna Commercial |
$270.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.53
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$276.92
|
| Rate for Payer: Health EOS Commercial |
$267.89
|
| Rate for Payer: HFN Commercial |
$276.92
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: NAPHCARE Commercial |
$180.60
|
| Rate for Payer: Preferred Network Access Commercial |
$276.92
|
| Rate for Payer: Quartz Beloit One Network |
$147.49
|
| Rate for Payer: Quartz Commercial |
$180.60
|
| Rate for Payer: WEA Trust Commercial |
$165.55
|
| Rate for Payer: WPS Commercial |
$222.95
|
|
|
MBMD HAND-SCORING STARTER KIT
|
Facility
|
OP
|
$4,332.00
|
|
| Hospital Charge Code |
2973504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,212.96 |
| Max. Negotiated Rate |
$17,328.00 |
| Rate for Payer: Aetna Commercial |
$3,898.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,725.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,212.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,815.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,079.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,295.96
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cigna Commercial |
$3,985.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,424.19
|
| Rate for Payer: Health EOS Commercial |
$3,855.48
|
| Rate for Payer: HFN Commercial |
$3,985.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,249.00
|
| Rate for Payer: Multiplan Commercial |
$3,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,599.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,985.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,122.68
|
| Rate for Payer: Quartz Commercial |
$2,815.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,599.20
|
| Rate for Payer: The Alliance Commercial |
$17,328.00
|
| Rate for Payer: WEA Trust Commercial |
$2,382.60
|
| Rate for Payer: WPS Commercial |
$3,208.71
|
|
|
MBMD HAND-SCORING STARTER KIT
|
Facility
|
IP
|
$4,332.00
|
|
| Hospital Charge Code |
2973504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,122.68 |
| Max. Negotiated Rate |
$3,985.44 |
| Rate for Payer: Aetna Commercial |
$3,898.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,725.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,295.96
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cigna Commercial |
$3,985.44
|
| Rate for Payer: Health EOS Commercial |
$3,855.48
|
| Rate for Payer: HFN Commercial |
$3,985.44
|
| Rate for Payer: Multiplan Commercial |
$3,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,599.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,985.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,122.68
|
| Rate for Payer: Quartz Commercial |
$2,599.20
|
| Rate for Payer: WEA Trust Commercial |
$2,382.60
|
| Rate for Payer: WPS Commercial |
$3,208.71
|
|
|
MCC Observation Per Hour
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040431
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
MCC Observation Per Hour
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040431
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,992.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,030.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,729.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.70
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.20
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: United Healthcare PPO |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
MCDONALD SUTURE/CERVICAL CERCLAGE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959921
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
MCDONALD SUTURE/CERVICAL CERCLAGE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959921
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
MC Flu Admin Charge 90471
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5609735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
MC Flu Admin Charge 90471
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5609735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
MCMI-III HAND-SCORING
|
Facility
|
OP
|
$4,660.00
|
|
| Hospital Charge Code |
2973530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,304.80 |
| Max. Negotiated Rate |
$18,640.00 |
| Rate for Payer: Aetna Commercial |
$4,194.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,007.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,304.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,029.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,236.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,469.80
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$4,287.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,607.74
|
| Rate for Payer: Health EOS Commercial |
$4,147.40
|
| Rate for Payer: HFN Commercial |
$4,287.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,495.00
|
| Rate for Payer: Multiplan Commercial |
$3,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,796.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,287.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,283.40
|
| Rate for Payer: Quartz Commercial |
$3,029.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,796.00
|
| Rate for Payer: The Alliance Commercial |
$18,640.00
|
| Rate for Payer: WEA Trust Commercial |
$2,563.00
|
| Rate for Payer: WPS Commercial |
$3,451.66
|
|
|
MCMI-III HAND-SCORING
|
Facility
|
IP
|
$4,660.00
|
|
| Hospital Charge Code |
2973530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,283.40 |
| Max. Negotiated Rate |
$4,287.20 |
| Rate for Payer: Aetna Commercial |
$4,194.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,007.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,469.80
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$4,287.20
|
| Rate for Payer: Health EOS Commercial |
$4,147.40
|
| Rate for Payer: HFN Commercial |
$4,287.20
|
| Rate for Payer: Multiplan Commercial |
$3,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,796.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,287.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,283.40
|
| Rate for Payer: Quartz Commercial |
$2,796.00
|
| Rate for Payer: WEA Trust Commercial |
$2,563.00
|
| Rate for Payer: WPS Commercial |
$3,451.66
|
|
|
MC Tobacco Counseling 3-10 Minutes G0436
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
2957679
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$41.90 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.40
|
| Rate for Payer: Health EOS Commercial |
$17.29
|
| Rate for Payer: HFN Commercial |
$18.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.90
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Preferred Network Access Commercial |
$18.05
|
| Rate for Payer: Quartz Beloit One Network |
$8.36
|
| Rate for Payer: Quartz Commercial |
$10.83
|
| Rate for Payer: The Alliance Commercial |
$9.50
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
