|
MAJOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$27,146.00
|
|
|
Service Code
|
MSDRG 596
|
| Min. Negotiated Rate |
$9,764.63 |
| Max. Negotiated Rate |
$27,146.00 |
| Rate for Payer: NAPHCARE Commercial |
$14,646.94
|
| Rate for Payer: Quartz Medicare Advantage |
$9,764.63
|
| Rate for Payer: The Alliance Commercial |
$27,146.00
|
| Rate for Payer: Aetna Managed Medicare |
$9,764.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,241.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,430.78
|
| Rate for Payer: Anthem Medicare Advantage |
$9,764.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,764.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,764.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,764.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,129.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,764.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,675.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,764.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,764.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,764.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,764.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,764.63
|
| Rate for Payer: United Healthcare PPO |
$15,317.63
|
| Rate for Payer: Wellcare Medicare |
$9,764.63
|
|
|
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$63,385.00
|
|
|
Service Code
|
MSDRG 330
|
| Min. Negotiated Rate |
$22,800.36 |
| Max. Negotiated Rate |
$63,385.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,800.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,722.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,111.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,208.86
|
| Rate for Payer: Anthem Medicare Advantage |
$22,800.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,800.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,800.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,800.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,195.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,800.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,255.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,800.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,800.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,800.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,800.36
|
| Rate for Payer: NAPHCARE Commercial |
$34,200.54
|
| Rate for Payer: Quartz Medicare Advantage |
$22,800.36
|
| Rate for Payer: The Alliance Commercial |
$63,385.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,800.36
|
| Rate for Payer: United Healthcare PPO |
$36,010.85
|
| Rate for Payer: Wellcare Medicare |
$22,800.36
|
|
|
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$120,404.00
|
|
|
Service Code
|
MSDRG 329
|
| Min. Negotiated Rate |
$43,310.75 |
| Max. Negotiated Rate |
$120,404.00 |
| Rate for Payer: Aetna Managed Medicare |
$43,310.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94,829.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72,686.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69,056.56
|
| Rate for Payer: Anthem Medicare Advantage |
$43,310.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,310.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,310.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,310.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76,659.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,310.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88,077.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,310.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,310.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,310.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,310.75
|
| Rate for Payer: NAPHCARE Commercial |
$64,966.12
|
| Rate for Payer: Quartz Medicare Advantage |
$43,310.75
|
| Rate for Payer: The Alliance Commercial |
$120,404.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,310.75
|
| Rate for Payer: United Healthcare PPO |
$68,569.54
|
| Rate for Payer: Wellcare Medicare |
$43,310.75
|
|
|
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,772.00
|
|
|
Service Code
|
MSDRG 331
|
| Min. Negotiated Rate |
$16,105.10 |
| Max. Negotiated Rate |
$44,772.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,105.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,036.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,855.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,514.26
|
| Rate for Payer: Anthem Medicare Advantage |
$16,105.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,105.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,105.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,105.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,323.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,105.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,604.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,105.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,105.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,105.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,105.10
|
| Rate for Payer: NAPHCARE Commercial |
$24,157.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16,105.10
|
| Rate for Payer: The Alliance Commercial |
$44,772.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,105.10
|
| Rate for Payer: United Healthcare PPO |
$25,382.63
|
| Rate for Payer: Wellcare Medicare |
$16,105.10
|
|
|
MAJOR THUMB OR JOINT PROCEDURES
|
Facility
|
IP
|
$39,205.00
|
|
|
Service Code
|
MSDRG 506
|
| Min. Negotiated Rate |
$14,102.54 |
| Max. Negotiated Rate |
$39,205.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,102.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,630.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,478.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,305.88
|
| Rate for Payer: Anthem Medicare Advantage |
$14,102.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,102.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,102.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,102.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,761.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,102.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,520.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,102.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,102.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,102.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,102.54
|
| Rate for Payer: NAPHCARE Commercial |
$21,153.81
|
| Rate for Payer: Quartz Medicare Advantage |
$14,102.54
|
| Rate for Payer: The Alliance Commercial |
$39,205.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,102.54
|
| Rate for Payer: United Healthcare PPO |
$22,203.73
|
| Rate for Payer: Wellcare Medicare |
$14,102.54
|
|
|
Malaria Smear
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
633784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$5.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.94
|
| Rate for Payer: Anthem Medicaid |
$6.19
|
| Rate for Payer: Anthem Medicare Advantage |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.99
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Dean Health Medicaid |
$6.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.99
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$8.98
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.19
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5.99
|
| Rate for Payer: The Alliance Commercial |
$23.96
|
| Rate for Payer: United Healthcare Medicaid |
$6.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare PPO |
$128.25
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: Wellcare Medicare |
$5.99
|
| Rate for Payer: WMAP Medicaid |
$6.19
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
Malaria Smear
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
633784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna Commercial |
$162.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$162.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.60
|
| Rate for Payer: Health EOS Commercial |
$155.61
|
| Rate for Payer: HFN Commercial |
$162.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$162.45
|
| Rate for Payer: Quartz Beloit One Network |
$75.24
|
| Rate for Payer: Quartz Commercial |
$97.47
|
| Rate for Payer: The Alliance Commercial |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
Malaria Smear
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
633784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$29,158.00
|
|
|
Service Code
|
MSDRG 755
|
| Min. Negotiated Rate |
$10,488.58 |
| Max. Negotiated Rate |
$29,158.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,488.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,367.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,500.24
|
| Rate for Payer: Anthem Medicare Advantage |
$10,488.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,488.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,488.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,488.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,316.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,488.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,151.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,488.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,488.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,488.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,488.58
|
| Rate for Payer: NAPHCARE Commercial |
$15,732.87
|
| Rate for Payer: Quartz Medicare Advantage |
$10,488.58
|
| Rate for Payer: The Alliance Commercial |
$29,158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,488.58
|
| Rate for Payer: United Healthcare PPO |
$16,466.83
|
| Rate for Payer: Wellcare Medicare |
$10,488.58
|
|
|
MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$49,571.00
|
|
|
Service Code
|
MSDRG 754
|
| Min. Negotiated Rate |
$17,831.27 |
| Max. Negotiated Rate |
$49,571.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,831.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,813.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,749.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,264.30
|
| Rate for Payer: Anthem Medicare Advantage |
$17,831.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,831.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,831.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,831.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,375.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,831.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,123.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,831.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,831.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,831.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,831.27
|
| Rate for Payer: NAPHCARE Commercial |
$26,746.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17,831.27
|
| Rate for Payer: The Alliance Commercial |
$49,571.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,831.27
|
| Rate for Payer: United Healthcare PPO |
$28,122.80
|
| Rate for Payer: Wellcare Medicare |
$17,831.27
|
|
|
MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$26,633.00
|
|
|
Service Code
|
MSDRG 756
|
| Min. Negotiated Rate |
$9,580.06 |
| Max. Negotiated Rate |
$26,633.00 |
| Rate for Payer: NAPHCARE Commercial |
$14,370.09
|
| Rate for Payer: Quartz Medicare Advantage |
$9,580.06
|
| Rate for Payer: The Alliance Commercial |
$26,633.00
|
| Rate for Payer: Aetna Managed Medicare |
$9,580.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,580.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,580.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,580.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,580.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,580.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,299.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,580.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,580.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,580.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,580.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,580.06
|
| Rate for Payer: United Healthcare PPO |
$15,024.64
|
| Rate for Payer: Wellcare Medicare |
$9,580.06
|
|
|
MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$29,945.00
|
|
|
Service Code
|
MSDRG 723
|
| Min. Negotiated Rate |
$10,771.64 |
| Max. Negotiated Rate |
$29,945.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,771.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,287.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,849.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,958.58
|
| Rate for Payer: Anthem Medicare Advantage |
$10,771.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,771.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,771.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,771.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,825.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,771.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,728.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,771.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,771.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,771.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,771.64
|
| Rate for Payer: NAPHCARE Commercial |
$16,157.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,771.64
|
| Rate for Payer: The Alliance Commercial |
$29,945.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,771.64
|
| Rate for Payer: United Healthcare PPO |
$16,916.19
|
| Rate for Payer: Wellcare Medicare |
$10,771.64
|
|
|
MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$50,164.00
|
|
|
Service Code
|
MSDRG 722
|
| Min. Negotiated Rate |
$18,044.53 |
| Max. Negotiated Rate |
$50,164.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,044.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,232.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,071.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,569.86
|
| Rate for Payer: Anthem Medicare Advantage |
$18,044.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,044.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,044.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,044.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,715.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,044.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,558.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,044.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,044.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,044.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,044.53
|
| Rate for Payer: NAPHCARE Commercial |
$27,066.80
|
| Rate for Payer: Quartz Medicare Advantage |
$18,044.53
|
| Rate for Payer: The Alliance Commercial |
$50,164.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,044.53
|
| Rate for Payer: United Healthcare PPO |
$28,461.34
|
| Rate for Payer: Wellcare Medicare |
$18,044.53
|
|
|
MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$21,842.00
|
|
|
Service Code
|
MSDRG 724
|
| Min. Negotiated Rate |
$7,856.75 |
| Max. Negotiated Rate |
$21,842.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,856.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,993.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,025.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,375.18
|
| Rate for Payer: Anthem Medicare Advantage |
$7,856.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,856.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,856.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,856.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,737.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,856.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,785.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,856.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,856.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,856.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,856.75
|
| Rate for Payer: NAPHCARE Commercial |
$11,785.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7,856.75
|
| Rate for Payer: The Alliance Commercial |
$21,842.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,856.75
|
| Rate for Payer: United Healthcare PPO |
$12,289.02
|
| Rate for Payer: Wellcare Medicare |
$7,856.75
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC
|
Facility
|
IP
|
$29,584.00
|
|
|
Service Code
|
MSDRG 436
|
| Min. Negotiated Rate |
$10,641.58 |
| Max. Negotiated Rate |
$29,584.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,641.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,078.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,689.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,805.80
|
| Rate for Payer: Anthem Medicare Advantage |
$10,641.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,641.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,641.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,641.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,655.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,641.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,463.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,641.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,641.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,641.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,641.58
|
| Rate for Payer: NAPHCARE Commercial |
$15,962.37
|
| Rate for Payer: Quartz Medicare Advantage |
$10,641.58
|
| Rate for Payer: The Alliance Commercial |
$29,584.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,641.58
|
| Rate for Payer: United Healthcare PPO |
$16,709.73
|
| Rate for Payer: Wellcare Medicare |
$10,641.58
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC
|
Facility
|
IP
|
$47,109.00
|
|
|
Service Code
|
MSDRG 435
|
| Min. Negotiated Rate |
$16,945.70 |
| Max. Negotiated Rate |
$47,109.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,945.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,924.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,302.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,889.28
|
| Rate for Payer: Anthem Medicare Advantage |
$16,945.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,945.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,945.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,945.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,849.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,945.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,318.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,945.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,945.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,945.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,945.70
|
| Rate for Payer: NAPHCARE Commercial |
$25,418.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16,945.70
|
| Rate for Payer: The Alliance Commercial |
$47,109.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,945.70
|
| Rate for Payer: United Healthcare PPO |
$26,717.04
|
| Rate for Payer: Wellcare Medicare |
$16,945.70
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,416.00
|
|
|
Service Code
|
MSDRG 437
|
| Min. Negotiated Rate |
$8,063.33 |
| Max. Negotiated Rate |
$22,416.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,063.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,413.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,347.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,680.74
|
| Rate for Payer: Anthem Medicare Advantage |
$8,063.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,063.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,063.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,063.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,076.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,063.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,206.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,063.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,063.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,063.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,063.33
|
| Rate for Payer: NAPHCARE Commercial |
$12,095.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,063.33
|
| Rate for Payer: The Alliance Commercial |
$22,416.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,063.33
|
| Rate for Payer: United Healthcare PPO |
$12,616.93
|
| Rate for Payer: Wellcare Medicare |
$8,063.33
|
|
|
MALIGNANT BREAST DISORDERS WITH CC
|
Facility
|
IP
|
$32,192.00
|
|
|
Service Code
|
MSDRG 598
|
| Min. Negotiated Rate |
$11,579.74 |
| Max. Negotiated Rate |
$32,192.00 |
| Rate for Payer: Quartz Medicare Advantage |
$11,579.74
|
| Rate for Payer: The Alliance Commercial |
$32,192.00
|
| Rate for Payer: Aetna Managed Medicare |
$11,579.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,579.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,579.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,579.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,579.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,579.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,376.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,579.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,579.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,579.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,579.74
|
| Rate for Payer: NAPHCARE Commercial |
$17,369.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,579.74
|
| Rate for Payer: United Healthcare PPO |
$18,198.98
|
| Rate for Payer: Wellcare Medicare |
$11,579.74
|
|
|
MALIGNANT BREAST DISORDERS WITH MCC
|
Facility
|
IP
|
$42,871.00
|
|
|
Service Code
|
MSDRG 597
|
| Min. Negotiated Rate |
$15,421.32 |
| Max. Negotiated Rate |
$42,871.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,421.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,568.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,729.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,444.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15,421.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,421.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,421.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,421.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,135.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,421.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,209.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,421.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,421.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,421.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,421.32
|
| Rate for Payer: NAPHCARE Commercial |
$23,131.98
|
| Rate for Payer: Quartz Medicare Advantage |
$15,421.32
|
| Rate for Payer: The Alliance Commercial |
$42,871.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,421.32
|
| Rate for Payer: United Healthcare PPO |
$24,297.19
|
| Rate for Payer: Wellcare Medicare |
$15,421.32
|
|
|
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,207.00
|
|
|
Service Code
|
MSDRG 599
|
| Min. Negotiated Rate |
$6,549.44 |
| Max. Negotiated Rate |
$18,207.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,549.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,007.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,970.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,472.36
|
| Rate for Payer: Anthem Medicare Advantage |
$6,549.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,549.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,549.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,549.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,515.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,549.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,117.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,549.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,549.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,549.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,549.44
|
| Rate for Payer: NAPHCARE Commercial |
$9,824.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6,549.44
|
| Rate for Payer: The Alliance Commercial |
$18,207.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,549.44
|
| Rate for Payer: United Healthcare PPO |
$9,433.47
|
| Rate for Payer: Wellcare Medicare |
$6,549.44
|
|
|
MALT1 Cytogenetics 88271
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$215.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.20
|
| Rate for Payer: Health EOS Commercial |
$206.57
|
| Rate for Payer: HFN Commercial |
$215.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$215.65
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$129.39
|
| Rate for Payer: The Alliance Commercial |
$113.50
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
MALT1 Cytogenetics 88271
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
MALT1 Cytogenetics 88271
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$170.25
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
MALT1 Cytogenetics 88275
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$215.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.20
|
| Rate for Payer: Health EOS Commercial |
$206.57
|
| Rate for Payer: HFN Commercial |
$215.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.70
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$215.65
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$129.39
|
| Rate for Payer: The Alliance Commercial |
$113.50
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
MALT1 Cytogenetics 88275
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776834
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
