|
Lymphocyte Abssolute Natural Killer (CD16 & CD56) Count
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
2942946
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.19 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna Commercial |
$420.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$420.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.80
|
| Rate for Payer: Health EOS Commercial |
$403.13
|
| Rate for Payer: HFN Commercial |
$420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Preferred Network Access Commercial |
$420.85
|
| Rate for Payer: Quartz Beloit One Network |
$194.92
|
| Rate for Payer: Quartz Commercial |
$252.51
|
| Rate for Payer: The Alliance Commercial |
$221.50
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
Lymphocyte Mitogen Screen,CC
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
3315519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$196.12 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$49.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.39
|
| Rate for Payer: Anthem Medicaid |
$50.66
|
| Rate for Payer: Anthem Medicare Advantage |
$49.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.03
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Dean Health Medicaid |
$50.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49.03
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$50.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.03
|
| Rate for Payer: Managed Health Services Medicaid |
$52.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49.03
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$73.54
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50.66
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$49.03
|
| Rate for Payer: The Alliance Commercial |
$196.12
|
| Rate for Payer: United Healthcare Medicaid |
$50.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.03
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$49.03
|
| Rate for Payer: WMAP Medicaid |
$50.66
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Lymphocyte Mitogen Screen,CC
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
3315519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Lymphocyte Mitogen Screen,CC
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
3315519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$173.08 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.00
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: HFN Commercial |
$80.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.08
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: The Alliance Commercial |
$42.50
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Lymphocyte panel T cell
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4746613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$150.92 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Lymphocyte panel T cell
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4746613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$133.19 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: HFN Commercial |
$92.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: The Alliance Commercial |
$48.50
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Lymphocyte panel T cell
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4746613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Lymphocyte Subset Panel 1
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
983312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.19 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.40
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: HFN Commercial |
$326.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: The Alliance Commercial |
$172.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Lymphocyte Subset Panel 1
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
983312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.50
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Lymphocyte Subset Panel 1
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
983312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$206.40
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Lymphocyte Subset Panel 2
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4744606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$133.19 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.20
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| Rate for Payer: HFN Commercial |
$73.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| Rate for Payer: The Alliance Commercial |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Lymphocyte Subset Panel 2
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4744606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$150.92 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Lymphocyte Subset Panel 2
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4744606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Lymphocyte Subset Panel 4
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
983313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna Commercial |
$413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.00
|
| Rate for Payer: Health EOS Commercial |
$395.85
|
| Rate for Payer: HFN Commercial |
$413.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.25
|
| Rate for Payer: Quartz Beloit One Network |
$191.40
|
| Rate for Payer: Quartz Commercial |
$247.95
|
| Rate for Payer: The Alliance Commercial |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
Lymphocyte Subset Panel 4
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
983313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
Lymphocyte Subset Panel 4
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
983313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$46.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.99
|
| Rate for Payer: Anthem Medicaid |
$48.54
|
| Rate for Payer: Anthem Medicare Advantage |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.98
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Dean Health Medicaid |
$48.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.98
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.98
|
| Rate for Payer: Managed Health Services Medicaid |
$50.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.98
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$70.47
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.54
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$46.98
|
| Rate for Payer: The Alliance Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicaid |
$48.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare PPO |
$326.25
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: Wellcare Medicare |
$46.98
|
| Rate for Payer: WMAP Medicaid |
$48.54
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
Lymphocyte Subset Panel 5
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
983314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Lymphocyte Subset Panel 5
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
983314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Aetna Managed Medicare |
$26.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.45
|
| Rate for Payer: Anthem Medicaid |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.78
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.46
|
| Rate for Payer: Dean Health Medicaid |
$27.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.78
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.78
|
| Rate for Payer: Managed Health Services Medicaid |
$28.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.78
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$40.17
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.67
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: Quartz Medicare Advantage |
$26.78
|
| Rate for Payer: The Alliance Commercial |
$107.12
|
| Rate for Payer: United Healthcare Medicaid |
$27.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.78
|
| Rate for Payer: United Healthcare PPO |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: Wellcare Medicare |
$26.78
|
| Rate for Payer: WMAP Medicaid |
$27.67
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Lymphocyte Subset Panel 5
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
983314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.53 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$342.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.00
|
| Rate for Payer: Health EOS Commercial |
$327.60
|
| Rate for Payer: HFN Commercial |
$342.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.53
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$342.00
|
| Rate for Payer: Quartz Beloit One Network |
$158.40
|
| Rate for Payer: Quartz Commercial |
$205.20
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Lymphogranuloma Venereum Panel
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4768634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Lymphogranuloma Venereum Panel
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4768634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.00
|
| Rate for Payer: Health EOS Commercial |
$9.10
|
| Rate for Payer: HFN Commercial |
$9.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.72
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.50
|
| Rate for Payer: Quartz Beloit One Network |
$4.40
|
| Rate for Payer: Quartz Commercial |
$5.70
|
| Rate for Payer: The Alliance Commercial |
$5.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Lymphogranuloma Venereum Panel
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4768634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$47.28 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$11.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.62
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.82
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.82
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.82
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$11.82
|
| Rate for Payer: The Alliance Commercial |
$47.28
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.82
|
| Rate for Payer: United Healthcare PPO |
$7.50
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: Wellcare Medicare |
$11.82
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$59,663.00
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$21,461.51 |
| Max. Negotiated Rate |
$59,663.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,461.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,785.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,860.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,069.94
|
| Rate for Payer: Anthem Medicare Advantage |
$21,461.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,461.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,461.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,461.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,820.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,461.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,525.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,461.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,461.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,461.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,461.51
|
| Rate for Payer: NAPHCARE Commercial |
$32,192.26
|
| Rate for Payer: Quartz Medicare Advantage |
$21,461.51
|
| Rate for Payer: The Alliance Commercial |
$59,663.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,461.51
|
| Rate for Payer: United Healthcare PPO |
$33,885.51
|
| Rate for Payer: Wellcare Medicare |
$21,461.51
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$161,078.00
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$57,941.63 |
| Max. Negotiated Rate |
$161,078.00 |
| Rate for Payer: Aetna Managed Medicare |
$57,941.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126,929.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97,290.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92,431.90
|
| Rate for Payer: Anthem Medicare Advantage |
$57,941.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57,941.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57,941.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$57,941.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102,607.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$57,941.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117,910.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57,941.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57,941.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$57,941.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$57,941.63
|
| Rate for Payer: NAPHCARE Commercial |
$86,912.44
|
| Rate for Payer: Quartz Medicare Advantage |
$57,941.63
|
| Rate for Payer: The Alliance Commercial |
$161,078.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57,941.63
|
| Rate for Payer: United Healthcare PPO |
$91,794.95
|
| Rate for Payer: Wellcare Medicare |
$57,941.63
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,255.00
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$11,962.27 |
| Max. Negotiated Rate |
$33,255.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,962.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,015.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,940.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,944.72
|
| Rate for Payer: Anthem Medicare Advantage |
$11,962.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,962.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,962.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,962.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,030.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,962.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,156.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,962.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,962.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,962.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,962.27
|
| Rate for Payer: NAPHCARE Commercial |
$17,943.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11,962.27
|
| Rate for Payer: The Alliance Commercial |
$33,255.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,962.27
|
| Rate for Payer: United Healthcare PPO |
$18,806.22
|
| Rate for Payer: Wellcare Medicare |
$11,962.27
|
|
