|
Mayo, Kappa & Lambda FISH
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
4574693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$167.23
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Mayo, Kappa & Lambda FISH
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
4574693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.04 |
| Max. Negotiated Rate |
$506.65 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$78.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.98
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$167.23
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$181.17
|
| Rate for Payer: Quartz Medicare Advantage |
$167.23
|
| Rate for Payer: The Alliance Commercial |
$506.65
|
| Rate for Payer: United Healthcare PPO |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Mayo, Kappa & Lambda ISH
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
Mayo, Kappa & Lambda ISH
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
4574694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| 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 |
$237.57
|
| 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 |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| 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 |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| 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 |
$336.18
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
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 |
$953.97 |
| Max. Negotiated Rate |
$1,791.13 |
| Rate for Payer: Aetna Commercial |
$1,752.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.85
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,791.13
|
| Rate for Payer: Health EOS Commercial |
$1,732.72
|
| Rate for Payer: HFN Commercial |
$1,791.13
|
| Rate for Payer: Multiplan Commercial |
$1,557.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.13
|
| Rate for Payer: Quartz Beloit One Network |
$953.97
|
| Rate for Payer: Quartz Commercial |
$1,168.13
|
| Rate for Payer: WEA Trust Commercial |
$1,070.78
|
| Rate for Payer: WPS Commercial |
$1,442.00
|
|
|
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 |
$847.89 |
| Max. Negotiated Rate |
$3,391.56 |
| Rate for Payer: Aetna Commercial |
$1,752.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.32
|
| Rate for Payer: Aetna Managed Medicare |
$847.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,314.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,546.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,467.30
|
| Rate for Payer: Anthem Medicare Advantage |
$847.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$847.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$847.89
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,791.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$847.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$847.89
|
| Rate for Payer: Health EOS Commercial |
$1,732.72
|
| Rate for Payer: HFN Commercial |
$1,791.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,154.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$847.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$847.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$847.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$847.89
|
| Rate for Payer: Multiplan Commercial |
$1,557.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,271.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.13
|
| Rate for Payer: Quartz Beloit One Network |
$953.97
|
| Rate for Payer: Quartz Commercial |
$1,265.47
|
| Rate for Payer: Quartz Medicare Advantage |
$847.89
|
| Rate for Payer: The Alliance Commercial |
$3,391.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$847.89
|
| Rate for Payer: United Healthcare PPO |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,070.78
|
| Rate for Payer: Wellcare Medicare |
$847.89
|
| Rate for Payer: WPS Commercial |
$1,442.00
|
|
|
Mayo, Renal Path Level IV
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
4574685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: United Healthcare PPO |
$478.92
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
Mayo, Renal Path Level IV
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
4574685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
Mayo, Slide Review
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
4605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.72 |
| Max. Negotiated Rate |
$821.25 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$186.65
|
| Rate for Payer: Anthem Commercial |
$43.72
|
| Rate for Payer: Anthem Medicare Advantage |
$186.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$186.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$186.65
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.65
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$708.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$708.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$186.65
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$279.97
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: Quartz Medicare Advantage |
$186.65
|
| Rate for Payer: The Alliance Commercial |
$737.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.65
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$821.25
|
|
|
Mayo, Slide Review
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
4605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Mayo, Slide Review
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 88381
|
| Hospital Charge Code |
4605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$746.60 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$69.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$149.76
|
| Rate for Payer: The Alliance Commercial |
$746.60
|
| Rate for Payer: United Healthcare PPO |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Mayo, Special Stain
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
4574686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$201.45
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: United Healthcare PPO |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
Mayo, Special Stain
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
4574686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$185.95
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
Mayo, Special Stain (s)
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
4574687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.39 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$281.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.91
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Health EOS Commercial |
$278.61
|
| Rate for Payer: HFN Commercial |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Preferred Network Access Commercial |
$288.00
|
| Rate for Payer: Quartz Beloit One Network |
$153.39
|
| Rate for Payer: Quartz Commercial |
$187.82
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
Mayo, Special Stain (s)
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
4574687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.38 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$281.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.38
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$278.61
|
| Rate for Payer: HFN Commercial |
$288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$288.00
|
| Rate for Payer: Quartz Beloit One Network |
$153.39
|
| Rate for Payer: Quartz Commercial |
$203.48
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$234.78
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
MBMD HAND-SCORING STARTER KIT
|
Facility
|
IP
|
$4,332.00
|
|
| Hospital Charge Code |
2973504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,207.59 |
| Max. Negotiated Rate |
$4,144.86 |
| Rate for Payer: Aetna Commercial |
$4,054.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,874.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,387.80
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cigna Commercial |
$4,144.86
|
| Rate for Payer: Health EOS Commercial |
$4,009.70
|
| Rate for Payer: HFN Commercial |
$4,144.86
|
| Rate for Payer: Multiplan Commercial |
$3,604.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,144.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,207.59
|
| Rate for Payer: Quartz Commercial |
$2,703.17
|
| Rate for Payer: WEA Trust Commercial |
$2,477.90
|
| Rate for Payer: WPS Commercial |
$3,336.94
|
|
|
MBMD HAND-SCORING STARTER KIT
|
Facility
|
OP
|
$4,332.00
|
|
| Hospital Charge Code |
2973504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,261.48 |
| Max. Negotiated Rate |
$4,144.86 |
| Rate for Payer: Aetna Commercial |
$4,054.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,874.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,261.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,928.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,252.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,162.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,387.80
|
| Rate for Payer: Cash Price |
$1,299.60
|
| Rate for Payer: Cigna Commercial |
$4,144.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,521.22
|
| Rate for Payer: Health EOS Commercial |
$4,009.70
|
| Rate for Payer: HFN Commercial |
$4,144.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,378.96
|
| Rate for Payer: Multiplan Commercial |
$3,604.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.17
|
| Rate for Payer: Preferred Network Access Commercial |
$4,144.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,207.59
|
| Rate for Payer: Quartz Commercial |
$2,928.43
|
| Rate for Payer: Quartz Medicare Advantage |
$2,703.17
|
| Rate for Payer: The Alliance Commercial |
$2,252.64
|
| Rate for Payer: WEA Trust Commercial |
$2,477.90
|
| Rate for Payer: WPS Commercial |
$3,336.94
|
|
|
MCC Observation Per Hour
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040431
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$7,271.68 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,271.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,271.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,958.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$32.24
|
| Rate for Payer: United Healthcare PPO |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
MCC Observation Per Hour
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040431
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
MCDONALD SUTURE/CERVICAL CERCLAGE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959921
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
MCDONALD SUTURE/CERVICAL CERCLAGE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959921
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
MC Flu Admin Charge 90471
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5609735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
MC Flu Admin Charge 90471
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5609735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
MCMI-III HAND-SCORING
|
Facility
|
IP
|
$4,660.00
|
|
| Hospital Charge Code |
2973530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,374.74 |
| Max. Negotiated Rate |
$4,458.69 |
| Rate for Payer: Aetna Commercial |
$4,361.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,167.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,568.59
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$4,458.69
|
| Rate for Payer: Health EOS Commercial |
$4,313.30
|
| Rate for Payer: HFN Commercial |
$4,458.69
|
| Rate for Payer: Multiplan Commercial |
$3,877.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,458.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,374.74
|
| Rate for Payer: Quartz Commercial |
$2,907.84
|
| Rate for Payer: WEA Trust Commercial |
$2,665.52
|
| Rate for Payer: WPS Commercial |
$3,589.60
|
|
|
MCMI-III HAND-SCORING
|
Facility
|
OP
|
$4,660.00
|
|
| Hospital Charge Code |
2973530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,356.99 |
| Max. Negotiated Rate |
$4,458.69 |
| Rate for Payer: Aetna Commercial |
$4,361.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,167.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,150.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,423.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,326.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,568.59
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cigna Commercial |
$4,458.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,712.12
|
| Rate for Payer: Health EOS Commercial |
$4,313.30
|
| Rate for Payer: HFN Commercial |
$4,458.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,634.80
|
| Rate for Payer: Multiplan Commercial |
$3,877.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,907.84
|
| Rate for Payer: Preferred Network Access Commercial |
$4,458.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,374.74
|
| Rate for Payer: Quartz Commercial |
$3,150.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,907.84
|
| Rate for Payer: The Alliance Commercial |
$2,423.20
|
| Rate for Payer: WEA Trust Commercial |
$2,665.52
|
| Rate for Payer: WPS Commercial |
$3,589.60
|
|
