|
Lymphocyte Subset Panel 2
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4744606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Lymphocyte Subset Panel 2
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4744606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$172.65 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$154.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$172.65
|
|
|
Lymphocyte Subset Panel 2
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4744606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.14
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$156.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: United Healthcare PPO |
$60.06
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: Wellcare Medicare |
$39.24
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Lymphocyte Subset Panel 4
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
983313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
Lymphocyte Subset Panel 4
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
983313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.86 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$48.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.11
|
| Rate for Payer: Anthem Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.86
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$48.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$48.86
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$48.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$48.86
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$73.29
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$48.86
|
| Rate for Payer: The Alliance Commercial |
$195.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.86
|
| Rate for Payer: United Healthcare PPO |
$339.30
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: Wellcare Medicare |
$48.86
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
Lymphocyte Subset Panel 4
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
983313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.86 |
| Max. Negotiated Rate |
$429.78 |
| Rate for Payer: Aetna Commercial |
$429.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$48.86
|
| Rate for Payer: Anthem Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.86
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$429.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.86
|
| Rate for Payer: Health EOS Commercial |
$411.68
|
| Rate for Payer: HFN Commercial |
$429.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.86
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$73.29
|
| Rate for Payer: Preferred Network Access Commercial |
$429.78
|
| Rate for Payer: Quartz Beloit One Network |
$199.06
|
| Rate for Payer: Quartz Commercial |
$257.87
|
| Rate for Payer: Quartz Medicare Advantage |
$48.86
|
| Rate for Payer: The Alliance Commercial |
$192.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.86
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$214.98
|
|
|
Lymphocyte Subset Panel 5
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
983314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.46 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
Lymphocyte Subset Panel 5
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
983314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$27.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.23
|
| Rate for Payer: Anthem Medicare Advantage |
$27.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.85
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.85
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.85
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$41.78
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: Quartz Medicare Advantage |
$27.85
|
| Rate for Payer: The Alliance Commercial |
$111.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.85
|
| Rate for Payer: United Healthcare PPO |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: Wellcare Medicare |
$27.85
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
Lymphocyte Subset Panel 5
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
983314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Aetna Commercial |
$355.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$27.85
|
| Rate for Payer: Anthem Medicare Advantage |
$27.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.85
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$355.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.85
|
| Rate for Payer: Health EOS Commercial |
$340.70
|
| Rate for Payer: HFN Commercial |
$355.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.85
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$41.78
|
| Rate for Payer: Preferred Network Access Commercial |
$355.68
|
| Rate for Payer: Quartz Beloit One Network |
$164.74
|
| Rate for Payer: Quartz Commercial |
$213.41
|
| Rate for Payer: Quartz Medicare Advantage |
$27.85
|
| Rate for Payer: The Alliance Commercial |
$110.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.85
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$122.55
|
|
|
Lymphogranuloma Venereum Panel
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4768634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$54.09 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.29
|
| Rate for Payer: Anthem Medicare Advantage |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.29
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.29
|
| Rate for Payer: Health EOS Commercial |
$9.46
|
| Rate for Payer: HFN Commercial |
$9.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$18.44
|
| Rate for Payer: Preferred Network Access Commercial |
$9.88
|
| Rate for Payer: Quartz Beloit One Network |
$4.58
|
| Rate for Payer: Quartz Commercial |
$5.93
|
| Rate for Payer: Quartz Medicare Advantage |
$12.29
|
| Rate for Payer: The Alliance Commercial |
$48.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.29
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$54.09
|
|
|
Lymphogranuloma Venereum Panel
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4768634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
Lymphogranuloma Venereum Panel
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4768634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$49.17 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.41
|
| Rate for Payer: Anthem Medicare Advantage |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.29
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.29
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$18.44
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$12.29
|
| Rate for Payer: The Alliance Commercial |
$49.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.29
|
| Rate for Payer: United Healthcare PPO |
$7.80
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: Wellcare Medicare |
$12.29
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$62,049.52
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$17,650.42 |
| Max. Negotiated Rate |
$62,049.52 |
| Rate for Payer: Aetna Managed Medicare |
$17,650.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,844.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,438.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,569.38
|
| Rate for Payer: Anthem Medicare Advantage |
$17,650.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,650.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,650.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,650.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,485.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,650.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,266.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,650.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,650.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,650.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,650.42
|
| Rate for Payer: NAPHCARE Commercial |
$26,475.63
|
| Rate for Payer: Quartz Medicare Advantage |
$17,650.42
|
| Rate for Payer: The Alliance Commercial |
$62,049.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,650.42
|
| Rate for Payer: United Healthcare PPO |
$35,240.93
|
| Rate for Payer: Wellcare Medicare |
$17,650.42
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$167,521.12
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$45,420.58 |
| Max. Negotiated Rate |
$167,521.12 |
| Rate for Payer: Aetna Managed Medicare |
$45,420.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127,965.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98,084.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93,186.51
|
| Rate for Payer: Anthem Medicare Advantage |
$45,420.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45,420.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45,420.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$45,420.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103,445.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$45,420.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122,627.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45,420.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45,420.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$45,420.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$45,420.58
|
| Rate for Payer: NAPHCARE Commercial |
$68,130.86
|
| Rate for Payer: Quartz Medicare Advantage |
$45,420.58
|
| Rate for Payer: The Alliance Commercial |
$167,521.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45,420.58
|
| Rate for Payer: United Healthcare PPO |
$95,466.75
|
| Rate for Payer: Wellcare Medicare |
$45,420.58
|
|
|
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,585.20
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$9,727.26 |
| Max. Negotiated Rate |
$34,585.20 |
| Rate for Payer: Aetna Managed Medicare |
$9,727.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,270.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,135.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,130.50
|
| Rate for Payer: Anthem Medicare Advantage |
$9,727.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,727.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,727.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,727.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,236.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,727.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,122.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,727.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,727.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,727.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,727.26
|
| Rate for Payer: NAPHCARE Commercial |
$14,590.88
|
| Rate for Payer: Quartz Medicare Advantage |
$9,727.26
|
| Rate for Payer: The Alliance Commercial |
$34,585.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,727.26
|
| Rate for Payer: United Healthcare PPO |
$19,558.47
|
| Rate for Payer: Wellcare Medicare |
$9,727.26
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$43,839.12
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$13,000.35 |
| Max. Negotiated Rate |
$43,839.12 |
| Rate for Payer: Aetna Managed Medicare |
$13,000.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,595.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,283.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,921.51
|
| Rate for Payer: Anthem Medicare Advantage |
$13,000.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,000.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,000.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,000.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,775.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,000.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,910.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,000.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,000.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,000.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,000.35
|
| Rate for Payer: NAPHCARE Commercial |
$19,500.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13,000.35
|
| Rate for Payer: The Alliance Commercial |
$43,839.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,000.35
|
| Rate for Payer: United Healthcare PPO |
$24,842.79
|
| Rate for Payer: Wellcare Medicare |
$13,000.35
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$86,743.28
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$25,280.28 |
| Max. Negotiated Rate |
$86,743.28 |
| Rate for Payer: Aetna Managed Medicare |
$25,280.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,582.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,101.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,399.71
|
| Rate for Payer: Anthem Medicare Advantage |
$25,280.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,280.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,280.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,280.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57,058.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,280.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,379.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,280.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,280.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,280.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,280.28
|
| Rate for Payer: NAPHCARE Commercial |
$37,920.42
|
| Rate for Payer: Quartz Medicare Advantage |
$25,280.28
|
| Rate for Payer: The Alliance Commercial |
$86,743.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,280.28
|
| Rate for Payer: United Healthcare PPO |
$49,341.41
|
| Rate for Payer: Wellcare Medicare |
$25,280.28
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$62,071.36
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$17,857.20 |
| Max. Negotiated Rate |
$62,071.36 |
| Rate for Payer: Aetna Managed Medicare |
$17,857.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,433.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,890.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,998.39
|
| Rate for Payer: Anthem Medicare Advantage |
$17,857.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,857.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,857.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,857.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,961.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,857.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,283.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,857.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,857.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,857.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,857.20
|
| Rate for Payer: NAPHCARE Commercial |
$26,785.79
|
| Rate for Payer: Quartz Medicare Advantage |
$17,857.20
|
| Rate for Payer: The Alliance Commercial |
$62,071.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,857.20
|
| Rate for Payer: United Healthcare PPO |
$35,253.56
|
| Rate for Payer: Wellcare Medicare |
$17,857.20
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$124,808.32
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$36,590.05 |
| Max. Negotiated Rate |
$124,808.32 |
| Rate for Payer: Aetna Managed Medicare |
$36,590.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100,036.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,677.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72,848.44
|
| Rate for Payer: Anthem Medicare Advantage |
$36,590.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,590.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,590.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,590.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80,868.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,590.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91,298.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,590.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,590.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,590.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,590.05
|
| Rate for Payer: NAPHCARE Commercial |
$54,885.07
|
| Rate for Payer: Quartz Medicare Advantage |
$36,590.05
|
| Rate for Payer: The Alliance Commercial |
$124,808.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,590.05
|
| Rate for Payer: United Healthcare PPO |
$71,077.07
|
| Rate for Payer: Wellcare Medicare |
$36,590.05
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,040.16
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$10,840.76 |
| Max. Negotiated Rate |
$36,040.16 |
| Rate for Payer: Aetna Managed Medicare |
$10,840.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,442.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,567.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,440.78
|
| Rate for Payer: Anthem Medicare Advantage |
$10,840.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,840.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,840.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,840.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,801.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,840.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,189.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,840.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,840.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,840.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,840.76
|
| Rate for Payer: NAPHCARE Commercial |
$16,261.14
|
| Rate for Payer: Quartz Medicare Advantage |
$10,840.76
|
| Rate for Payer: The Alliance Commercial |
$36,040.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,840.76
|
| Rate for Payer: United Healthcare PPO |
$20,388.93
|
| Rate for Payer: Wellcare Medicare |
$10,840.76
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$29,818.88
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$8,244.63 |
| Max. Negotiated Rate |
$29,818.88 |
| Rate for Payer: Aetna Managed Medicare |
$8,244.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,046.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,898.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,054.37
|
| Rate for Payer: Anthem Medicare Advantage |
$8,244.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,244.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,244.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,244.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,821.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,244.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,626.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,244.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,244.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,244.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,244.63
|
| Rate for Payer: NAPHCARE Commercial |
$12,366.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8,244.63
|
| Rate for Payer: The Alliance Commercial |
$29,818.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,244.63
|
| Rate for Payer: United Healthcare PPO |
$16,836.58
|
| Rate for Payer: Wellcare Medicare |
$8,244.63
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$32,618.11
|
|
|
Service Code
|
APR-DRG 6914
|
| Min. Negotiated Rate |
$28,973.44 |
| Max. Negotiated Rate |
$32,618.11 |
| Rate for Payer: Anthem Medicaid |
$31,233.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,233.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,233.64
|
| Rate for Payer: Dean Health Medicaid |
$31,233.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,973.44
|
| Rate for Payer: Managed Health Services Medicaid |
$32,618.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,233.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,233.64
|
| Rate for Payer: United Healthcare Medicaid |
$31,233.64
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 6911
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00801
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
IP
|
$19,202.60
|
|
|
Service Code
|
APR-DRG 6913
|
| Min. Negotiated Rate |
$17,056.95 |
| Max. Negotiated Rate |
$19,202.60 |
| Rate for Payer: Anthem Medicaid |
$18,387.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,387.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,387.55
|
| Rate for Payer: Dean Health Medicaid |
$18,387.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,056.95
|
| Rate for Payer: Managed Health Services Medicaid |
$19,202.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,387.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,387.55
|
| Rate for Payer: United Healthcare Medicaid |
$18,387.55
|
|
