|
Mayo, Copper Liver Ts
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
4860606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.91
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.91
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$19.36
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.91
|
| Rate for Payer: The Alliance Commercial |
$50.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.91
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$56.79
|
|
|
Mayo, Copper Liver Ts
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
4860606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.91
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.91
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$19.36
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12.91
|
| Rate for Payer: The Alliance Commercial |
$51.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.91
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$12.91
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Mayo, Cytogenetics DNA
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4574683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$89.11 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| 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 |
$50.71
|
| 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 |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| 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 |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| 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 |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$22.28
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Mayo, Cytogenetics DNA
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4574683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Mayo, Epstein-Barr ISH
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$836.84 |
| Rate for Payer: Aetna Commercial |
$836.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.56
|
| Rate for Payer: Aetna Managed Medicare |
$168.97
|
| Rate for Payer: Anthem Commercial |
$41.49
|
| Rate for Payer: Anthem Medicare Advantage |
$168.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.97
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$836.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.97
|
| Rate for Payer: Health EOS Commercial |
$801.60
|
| Rate for Payer: HFN Commercial |
$836.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$646.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$646.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.97
|
| Rate for Payer: Multiplan Commercial |
$704.70
|
| Rate for Payer: NAPHCARE Commercial |
$253.45
|
| Rate for Payer: Preferred Network Access Commercial |
$836.84
|
| Rate for Payer: Quartz Beloit One Network |
$387.59
|
| Rate for Payer: Quartz Commercial |
$502.10
|
| Rate for Payer: Quartz Medicare Advantage |
$168.97
|
| Rate for Payer: The Alliance Commercial |
$667.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.97
|
| Rate for Payer: WEA Trust Commercial |
$484.48
|
| Rate for Payer: WPS Commercial |
$743.46
|
|
|
Mayo, Epstein-Barr ISH
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$431.63 |
| Max. Negotiated Rate |
$810.41 |
| Rate for Payer: Aetna Commercial |
$792.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.87
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$810.41
|
| Rate for Payer: Health EOS Commercial |
$783.98
|
| Rate for Payer: HFN Commercial |
$810.41
|
| Rate for Payer: Multiplan Commercial |
$704.70
|
| Rate for Payer: Preferred Network Access Commercial |
$810.41
|
| Rate for Payer: Quartz Beloit One Network |
$431.63
|
| Rate for Payer: Quartz Commercial |
$528.53
|
| Rate for Payer: WEA Trust Commercial |
$484.48
|
| Rate for Payer: WPS Commercial |
$652.44
|
|
|
Mayo, Epstein-Barr ISH
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$810.41 |
| Rate for Payer: Aetna Commercial |
$792.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.56
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna Commercial |
$810.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$783.98
|
| Rate for Payer: HFN Commercial |
$810.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$704.70
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$810.41
|
| Rate for Payer: Quartz Beloit One Network |
$431.63
|
| Rate for Payer: Quartz Commercial |
$572.57
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$660.66
|
| Rate for Payer: WEA Trust Commercial |
$484.48
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$652.44
|
|
|
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 |
$556.99 |
| Max. Negotiated Rate |
$1,045.78 |
| Rate for Payer: Aetna Commercial |
$1,023.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$977.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.46
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cigna Commercial |
$1,045.78
|
| Rate for Payer: Health EOS Commercial |
$1,011.68
|
| Rate for Payer: HFN Commercial |
$1,045.78
|
| Rate for Payer: Multiplan Commercial |
$909.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.78
|
| Rate for Payer: Quartz Beloit One Network |
$556.99
|
| Rate for Payer: Quartz Commercial |
$682.03
|
| Rate for Payer: WEA Trust Commercial |
$625.20
|
| Rate for Payer: WPS Commercial |
$841.94
|
|
|
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 |
$179.30 |
| Max. Negotiated Rate |
$1,045.78 |
| Rate for Payer: Aetna Commercial |
$1,023.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$977.58
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cigna Commercial |
$1,045.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$1,011.68
|
| Rate for Payer: HFN Commercial |
$1,045.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$909.38
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.78
|
| Rate for Payer: Quartz Beloit One Network |
$556.99
|
| Rate for Payer: Quartz Commercial |
$738.87
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$852.54
|
| Rate for Payer: WEA Trust Commercial |
$625.20
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$841.94
|
|
|
Mayo, IF Ab Stain
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4605740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$427.52 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$45.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$97.34
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$97.34
|
| Rate for Payer: The Alliance Commercial |
$427.52
|
| Rate for Payer: United Healthcare PPO |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Mayo, IF Ab Stain
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4605740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$470.28 |
| Rate for Payer: Aetna Commercial |
$154.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$106.88
|
| Rate for Payer: Anthem Commercial |
$23.41
|
| Rate for Payer: Anthem Medicare Advantage |
$106.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.88
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$154.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Health EOS Commercial |
$147.64
|
| Rate for Payer: HFN Commercial |
$154.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$385.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.88
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$160.32
|
| Rate for Payer: Preferred Network Access Commercial |
$154.13
|
| Rate for Payer: Quartz Beloit One Network |
$71.39
|
| Rate for Payer: Quartz Commercial |
$92.48
|
| Rate for Payer: Quartz Medicare Advantage |
$106.88
|
| Rate for Payer: The Alliance Commercial |
$422.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.88
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$470.28
|
|
|
Mayo, IF Ab Stain
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4605740
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Mayo, IF Renal
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
4574691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.74
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$154.04
|
| Rate for Payer: Health EOS Commercial |
$149.02
|
| Rate for Payer: HFN Commercial |
$154.04
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: Preferred Network Access Commercial |
$154.04
|
| Rate for Payer: Quartz Beloit One Network |
$82.05
|
| Rate for Payer: Quartz Commercial |
$100.46
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: WPS Commercial |
$124.02
|
|
|
Mayo, IF Renal
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
4574691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$154.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$149.02
|
| Rate for Payer: HFN Commercial |
$154.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$154.04
|
| Rate for Payer: Quartz Beloit One Network |
$82.05
|
| Rate for Payer: Quartz Commercial |
$108.84
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$125.58
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$124.02
|
|
|
Mayo, IGH Amp Meth
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 81261
|
| Hospital Charge Code |
4588657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$823.64 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$205.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.81
|
| Rate for Payer: Anthem Medicare Advantage |
$205.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$205.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$205.91
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$205.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$205.91
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$205.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$205.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$205.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$205.91
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$308.86
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$187.93
|
| Rate for Payer: Quartz Medicare Advantage |
$205.91
|
| Rate for Payer: The Alliance Commercial |
$823.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$205.91
|
| Rate for Payer: United Healthcare PPO |
$216.84
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: Wellcare Medicare |
$205.91
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
Mayo, IGH Amp Meth
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 81261
|
| Hospital Charge Code |
4588657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$173.47
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
Mayo, IGH Clonal Pop
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 81264
|
| Hospital Charge Code |
4588658
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
Mayo, IGH Clonal Pop
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 81264
|
| Hospital Charge Code |
4588658
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$179.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$673.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$314.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.20
|
| Rate for Payer: Anthem Medicare Advantage |
$179.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.64
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.64
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$668.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.64
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$269.46
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$179.64
|
| Rate for Payer: The Alliance Commercial |
$718.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.64
|
| Rate for Payer: United Healthcare PPO |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: Wellcare Medicare |
$179.64
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
Mayo, Initial Stain
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
4574690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.83 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$324.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.27
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$332.01
|
| Rate for Payer: Health EOS Commercial |
$321.18
|
| Rate for Payer: HFN Commercial |
$332.01
|
| Rate for Payer: Multiplan Commercial |
$288.70
|
| Rate for Payer: Preferred Network Access Commercial |
$332.01
|
| Rate for Payer: Quartz Beloit One Network |
$176.83
|
| Rate for Payer: Quartz Commercial |
$216.53
|
| Rate for Payer: WEA Trust Commercial |
$198.48
|
| Rate for Payer: WPS Commercial |
$267.29
|
|
|
Mayo, Initial Stain
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
4574690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.83 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$324.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.36
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$332.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$321.18
|
| Rate for Payer: HFN Commercial |
$332.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$288.70
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$332.01
|
| Rate for Payer: Quartz Beloit One Network |
$176.83
|
| Rate for Payer: Quartz Commercial |
$234.57
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$270.66
|
| Rate for Payer: WEA Trust Commercial |
$198.48
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$267.29
|
|
|
Mayo, Interphases 100-300
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4574684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Mayo, Interphases 100-300
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4574684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$212.95 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| 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 |
$38.58
|
| 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 |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| 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 |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| 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 |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: Wellcare Medicare |
$53.24
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Mayo, Interphases 25-99
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
4605739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$176.30 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$44.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.16
|
| Rate for Payer: Anthem Medicare Advantage |
$44.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.08
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.08
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.08
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$66.11
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$44.08
|
| Rate for Payer: The Alliance Commercial |
$176.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.08
|
| Rate for Payer: United Healthcare PPO |
$52.26
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: Wellcare Medicare |
$44.08
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Mayo, Interphases 25-99
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
4605739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Mayo, Interphases 25-99
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
4605739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$193.93 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$44.08
|
| Rate for Payer: Anthem Medicare Advantage |
$44.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.08
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.08
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.08
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$66.11
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$44.08
|
| Rate for Payer: The Alliance Commercial |
$174.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.08
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$193.93
|
|
