|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 3821
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
MALIGNANT BREAST DISORDERS WITH CC
|
Facility
|
IP
|
$33,479.68
|
|
|
Service Code
|
MSDRG 598
|
| Min. Negotiated Rate |
$9,170.49 |
| Max. Negotiated Rate |
$33,479.68 |
| Rate for Payer: Aetna Managed Medicare |
$9,170.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,684.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,920.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,975.36
|
| Rate for Payer: Anthem Medicare Advantage |
$9,170.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,170.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,170.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,170.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,954.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,170.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,311.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,170.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,170.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,170.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,170.49
|
| Rate for Payer: NAPHCARE Commercial |
$13,755.74
|
| Rate for Payer: Quartz Medicare Advantage |
$9,170.49
|
| Rate for Payer: The Alliance Commercial |
$33,479.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,170.49
|
| Rate for Payer: United Healthcare PPO |
$18,926.94
|
| Rate for Payer: Wellcare Medicare |
$9,170.49
|
|
|
MALIGNANT BREAST DISORDERS WITH MCC
|
Facility
|
IP
|
$44,585.84
|
|
|
Service Code
|
MSDRG 597
|
| Min. Negotiated Rate |
$13,273.75 |
| Max. Negotiated Rate |
$44,585.84 |
| Rate for Payer: Aetna Managed Medicare |
$13,273.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,374.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,880.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,488.75
|
| Rate for Payer: Anthem Medicare Advantage |
$13,273.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,273.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,273.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,273.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,404.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,273.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,458.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,273.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,273.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,273.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,273.75
|
| Rate for Payer: NAPHCARE Commercial |
$19,910.62
|
| Rate for Payer: Quartz Medicare Advantage |
$13,273.75
|
| Rate for Payer: The Alliance Commercial |
$44,585.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,273.75
|
| Rate for Payer: United Healthcare PPO |
$25,269.08
|
| Rate for Payer: Wellcare Medicare |
$13,273.75
|
|
|
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,935.28
|
|
|
Service Code
|
MSDRG 599
|
| Min. Negotiated Rate |
$6,399.00 |
| Max. Negotiated Rate |
$18,935.28 |
| Rate for Payer: Aetna Managed Medicare |
$6,399.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,997.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,262.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,649.90
|
| Rate for Payer: Anthem Medicare Advantage |
$6,399.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,399.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,399.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,932.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,399.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,601.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,399.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,399.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,399.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,399.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,598.49
|
| Rate for Payer: Quartz Medicare Advantage |
$6,399.00
|
| Rate for Payer: The Alliance Commercial |
$18,935.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,399.00
|
| Rate for Payer: United Healthcare PPO |
$9,810.81
|
| Rate for Payer: Wellcare Medicare |
$6,399.00
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
EAPG 00690
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$36.53 |
| Rate for Payer: Anthem Medicaid |
$35.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.13
|
| Rate for Payer: Dean Health Medicaid |
$35.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.13
|
| Rate for Payer: Managed Health Services Medicaid |
$36.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.13
|
| Rate for Payer: United Healthcare Medicaid |
$35.13
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$6,663.92
|
|
|
Service Code
|
APR-DRG 4212
|
| Min. Negotiated Rate |
$5,919.31 |
| Max. Negotiated Rate |
$6,663.92 |
| Rate for Payer: Anthem Medicaid |
$6,381.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,381.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,381.07
|
| Rate for Payer: Dean Health Medicaid |
$6,381.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,919.31
|
| Rate for Payer: Managed Health Services Medicaid |
$6,663.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,381.07
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,381.07
|
| Rate for Payer: United Healthcare Medicaid |
$6,381.07
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$17,799.67
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$15,810.78 |
| Max. Negotiated Rate |
$17,799.67 |
| Rate for Payer: Anthem Medicaid |
$17,044.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,044.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,044.16
|
| Rate for Payer: Dean Health Medicaid |
$17,044.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,810.78
|
| Rate for Payer: Managed Health Services Medicaid |
$17,799.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,044.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,044.16
|
| Rate for Payer: United Healthcare Medicaid |
$17,044.16
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$4,559.52
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$4,050.05 |
| Max. Negotiated Rate |
$4,559.52 |
| Rate for Payer: Anthem Medicaid |
$4,365.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,365.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,365.99
|
| Rate for Payer: Dean Health Medicaid |
$4,365.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,050.05
|
| Rate for Payer: Managed Health Services Medicaid |
$4,559.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,365.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,365.99
|
| Rate for Payer: United Healthcare Medicaid |
$4,365.99
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$10,434.29
|
|
|
Service Code
|
APR-DRG 4213
|
| Min. Negotiated Rate |
$9,268.39 |
| Max. Negotiated Rate |
$10,434.29 |
| Rate for Payer: Anthem Medicaid |
$9,991.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,991.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,991.41
|
| Rate for Payer: Dean Health Medicaid |
$9,991.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,268.39
|
| Rate for Payer: Managed Health Services Medicaid |
$10,434.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,991.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,991.41
|
| Rate for Payer: United Healthcare Medicaid |
$9,991.41
|
|
|
MALT1 Cytogenetics 88271
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$22.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.98
|
| Rate for Payer: Anthem Medicare Advantage |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.28
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.28
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$22.28
|
| Rate for Payer: The Alliance Commercial |
$89.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.28
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$22.28
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
MALT1 Cytogenetics 88271
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
MALT1 Cytogenetics 88271
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$224.28 |
| Rate for Payer: Aetna Commercial |
$224.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$22.28
|
| Rate for Payer: Anthem Medicare Advantage |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.28
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$224.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$214.83
|
| Rate for Payer: HFN Commercial |
$224.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.28
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$224.28
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$134.57
|
| Rate for Payer: Quartz Medicare Advantage |
$22.28
|
| Rate for Payer: The Alliance Commercial |
$87.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.28
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$98.02
|
|
|
MALT1 Cytogenetics 88275
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$234.25 |
| Rate for Payer: Aetna Commercial |
$224.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$224.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$214.83
|
| Rate for Payer: HFN Commercial |
$224.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$224.28
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$134.57
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$210.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$234.25
|
|
|
MALT1 Cytogenetics 88275
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.37
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$212.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$53.24
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
MALT1 Cytogenetics 88275
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
MALT1 Interp & Report
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
MALT1 Interp & Report
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$132.95
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
MALT1 Interp & Report
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$33.24
|
| Rate for Payer: Anthem Commercial |
$5.89
|
| Rate for Payer: Anthem Medicare Advantage |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.24
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.24
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$49.86
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.24
|
| Rate for Payer: The Alliance Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.24
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$146.25
|
|
|
MA Mam Digital WWHSP Diag Bilat w/ CAD
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
5144731
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$156.03 |
| Max. Negotiated Rate |
$780.16 |
| Rate for Payer: Aetna Commercial |
$439.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$156.03
|
| Rate for Payer: Anthem Medicare Advantage |
$156.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.03
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$439.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.03
|
| Rate for Payer: Health EOS Commercial |
$421.15
|
| Rate for Payer: HFN Commercial |
$439.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$576.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.03
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$234.05
|
| Rate for Payer: Preferred Network Access Commercial |
$439.66
|
| Rate for Payer: Quartz Beloit One Network |
$203.63
|
| Rate for Payer: Quartz Commercial |
$263.80
|
| Rate for Payer: Quartz Medicare Advantage |
$156.03
|
| Rate for Payer: The Alliance Commercial |
$592.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.03
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$780.16
|
|
|
MA Mam Digital WWHSP Diag Bilat w/ CAD
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
5144731
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$226.77 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
MA Mam Digital WWHSP Diag Bilat w/ CAD
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
5144731
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$129.58 |
| Max. Negotiated Rate |
$624.12 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$129.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.99
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.10
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$277.68
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$300.82
|
| Rate for Payer: Quartz Medicare Advantage |
$277.68
|
| Rate for Payer: The Alliance Commercial |
$624.12
|
| Rate for Payer: United Healthcare PPO |
$347.10
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
MA Mam Digital WWHSP Diag Left w/ CAD
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 77065 LT
|
| Hospital Charge Code |
5144734
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$200.27 |
| Max. Negotiated Rate |
$376.02 |
| Rate for Payer: Aetna Commercial |
$367.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.62
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$376.02
|
| Rate for Payer: Health EOS Commercial |
$363.76
|
| Rate for Payer: HFN Commercial |
$376.02
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$376.02
|
| Rate for Payer: Quartz Beloit One Network |
$200.27
|
| Rate for Payer: Quartz Commercial |
$245.23
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
MA Mam Digital WWHSP Diag Left w/ CAD
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 77065 LT
|
| Hospital Charge Code |
5144734
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$376.02 |
| Rate for Payer: Aetna Commercial |
$367.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$114.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.62
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$376.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.73
|
| Rate for Payer: Health EOS Commercial |
$363.76
|
| Rate for Payer: HFN Commercial |
$376.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.54
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$245.23
|
| Rate for Payer: Preferred Network Access Commercial |
$376.02
|
| Rate for Payer: Quartz Beloit One Network |
$200.27
|
| Rate for Payer: Quartz Commercial |
$265.67
|
| Rate for Payer: Quartz Medicare Advantage |
$245.23
|
| Rate for Payer: The Alliance Commercial |
$204.36
|
| Rate for Payer: United Healthcare PPO |
$306.54
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
MA Mam Digital WWHSP Diag Left w/ CAD
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 77065 LT
|
| Hospital Charge Code |
5144734
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$455.59 |
| Rate for Payer: Aetna Commercial |
$388.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$388.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.23
|
| Rate for Payer: Health EOS Commercial |
$371.94
|
| Rate for Payer: HFN Commercial |
$388.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.59
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$388.28
|
| Rate for Payer: Quartz Beloit One Network |
$179.84
|
| Rate for Payer: Quartz Commercial |
$232.97
|
| Rate for Payer: The Alliance Commercial |
$204.36
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
MA Mam Digital WWHSP Diag Right w/ CAD
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 77065 RT
|
| Hospital Charge Code |
5144737
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$455.59 |
| Rate for Payer: Aetna Commercial |
$388.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$388.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.23
|
| Rate for Payer: Health EOS Commercial |
$371.94
|
| Rate for Payer: HFN Commercial |
$388.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.59
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$388.28
|
| Rate for Payer: Quartz Beloit One Network |
$179.84
|
| Rate for Payer: Quartz Commercial |
$232.97
|
| Rate for Payer: The Alliance Commercial |
$204.36
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
