|
Viral Culture, Non Respiratory Body Fluids
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
983433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$384.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.60
|
| Rate for Payer: Aetna Managed Medicare |
$27.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.01
|
| Rate for Payer: Anthem Medicare Advantage |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.11
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$393.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.11
|
| Rate for Payer: Health EOS Commercial |
$380.42
|
| Rate for Payer: HFN Commercial |
$393.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$341.95
|
| Rate for Payer: NAPHCARE Commercial |
$40.67
|
| Rate for Payer: Preferred Network Access Commercial |
$393.24
|
| Rate for Payer: Quartz Beloit One Network |
$209.45
|
| Rate for Payer: Quartz Commercial |
$277.84
|
| Rate for Payer: Quartz Medicare Advantage |
$27.11
|
| Rate for Payer: The Alliance Commercial |
$108.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare PPO |
$320.58
|
| Rate for Payer: WEA Trust Commercial |
$235.09
|
| Rate for Payer: Wellcare Medicare |
$27.11
|
| Rate for Payer: WPS Commercial |
$316.59
|
|
|
Viral Culture, Non Respiratory Body Fluids
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
983433
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$384.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.54
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$393.24
|
| Rate for Payer: Health EOS Commercial |
$380.42
|
| Rate for Payer: HFN Commercial |
$393.24
|
| Rate for Payer: Multiplan Commercial |
$341.95
|
| Rate for Payer: Preferred Network Access Commercial |
$393.24
|
| Rate for Payer: Quartz Beloit One Network |
$209.45
|
| Rate for Payer: Quartz Commercial |
$256.46
|
| Rate for Payer: WEA Trust Commercial |
$235.09
|
| Rate for Payer: WPS Commercial |
$316.59
|
|
|
.Viral ID Resp PCR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6182672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
.Viral ID Resp PCR
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6182672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$167.96 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$20.34
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$167.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$160.89
|
| Rate for Payer: HFN Commercial |
$167.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| Rate for Payer: Preferred Network Access Commercial |
$167.96
|
| Rate for Payer: Quartz Beloit One Network |
$77.79
|
| Rate for Payer: Quartz Commercial |
$100.78
|
| Rate for Payer: Quartz Medicare Advantage |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$80.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$89.51
|
|
|
.Viral ID Resp PCR
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6182672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$20.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.77
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$81.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: United Healthcare PPO |
$132.60
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: Wellcare Medicare |
$20.34
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$5,524.04
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$4,906.79 |
| Max. Negotiated Rate |
$5,524.04 |
| Rate for Payer: Anthem Medicaid |
$5,289.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,289.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,289.57
|
| Rate for Payer: Dean Health Medicaid |
$5,289.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,906.79
|
| Rate for Payer: Managed Health Services Medicaid |
$5,524.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,289.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,289.57
|
| Rate for Payer: United Healthcare Medicaid |
$5,289.57
|
|
|
VIRAL ILLNESS
|
Facility
|
OP
|
$93.03
|
|
|
Service Code
|
EAPG 00808
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$93.03 |
| Rate for Payer: Anthem Medicaid |
$89.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$89.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.45
|
| Rate for Payer: Dean Health Medicaid |
$89.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89.45
|
| Rate for Payer: Managed Health Services Medicaid |
$93.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$89.45
|
| Rate for Payer: United Healthcare Medicaid |
$89.45
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$17,536.62
|
|
|
Service Code
|
APR-DRG 7234
|
| Min. Negotiated Rate |
$15,577.12 |
| Max. Negotiated Rate |
$17,536.62 |
| Rate for Payer: Anthem Medicaid |
$16,792.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,792.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,792.28
|
| Rate for Payer: Dean Health Medicaid |
$16,792.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,577.12
|
| Rate for Payer: Managed Health Services Medicaid |
$17,536.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,792.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,792.28
|
| Rate for Payer: United Healthcare Medicaid |
$16,792.28
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 7233
|
| Min. Negotiated Rate |
$8,100.10 |
| Max. Negotiated Rate |
$9,119.04 |
| Rate for Payer: Anthem Medicaid |
$8,731.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,731.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,731.99
|
| Rate for Payer: Dean Health Medicaid |
$8,731.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,100.10
|
| Rate for Payer: Managed Health Services Medicaid |
$9,119.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,731.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,731.99
|
| Rate for Payer: United Healthcare Medicaid |
$8,731.99
|
|
|
VIRAL ILLNESS
|
Facility
|
IP
|
$3,858.06
|
|
|
Service Code
|
APR-DRG 7231
|
| Min. Negotiated Rate |
$3,426.97 |
| Max. Negotiated Rate |
$3,858.06 |
| Rate for Payer: Anthem Medicaid |
$3,694.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,694.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,694.30
|
| Rate for Payer: Dean Health Medicaid |
$3,694.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,426.97
|
| Rate for Payer: Managed Health Services Medicaid |
$3,858.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,694.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,694.30
|
| Rate for Payer: United Healthcare Medicaid |
$3,694.30
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$45,675.76
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$11,981.06 |
| Max. Negotiated Rate |
$45,675.76 |
| Rate for Payer: Aetna Managed Medicare |
$11,981.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,691.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,057.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,806.67
|
| Rate for Payer: Anthem Medicare Advantage |
$11,981.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,981.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,981.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,981.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,427.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,981.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,257.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,981.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,981.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,981.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,981.06
|
| Rate for Payer: NAPHCARE Commercial |
$17,971.59
|
| Rate for Payer: Quartz Medicare Advantage |
$11,981.06
|
| Rate for Payer: The Alliance Commercial |
$45,675.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,981.06
|
| Rate for Payer: United Healthcare PPO |
$25,891.13
|
| Rate for Payer: Wellcare Medicare |
$11,981.06
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$25,706.72
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$7,166.36 |
| Max. Negotiated Rate |
$25,706.72 |
| Rate for Payer: Aetna Managed Medicare |
$7,166.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,973.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,543.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,817.18
|
| Rate for Payer: Anthem Medicare Advantage |
$7,166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,166.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,166.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,338.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,166.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,610.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,166.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,166.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,166.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,166.36
|
| Rate for Payer: NAPHCARE Commercial |
$10,749.54
|
| Rate for Payer: Quartz Medicare Advantage |
$7,166.36
|
| Rate for Payer: The Alliance Commercial |
$25,706.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,166.36
|
| Rate for Payer: United Healthcare PPO |
$14,488.86
|
| Rate for Payer: Wellcare Medicare |
$7,166.36
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$7,716.11
|
|
|
Service Code
|
APR-DRG 0512
|
| Min. Negotiated Rate |
$6,853.93 |
| Max. Negotiated Rate |
$7,716.11 |
| Rate for Payer: Anthem Medicaid |
$7,388.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,388.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,388.60
|
| Rate for Payer: Dean Health Medicaid |
$7,388.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,853.93
|
| Rate for Payer: Managed Health Services Medicaid |
$7,716.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,388.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,388.60
|
| Rate for Payer: United Healthcare Medicaid |
$7,388.60
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$12,100.27
|
|
|
Service Code
|
APR-DRG 0513
|
| Min. Negotiated Rate |
$10,748.21 |
| Max. Negotiated Rate |
$12,100.27 |
| Rate for Payer: Anthem Medicaid |
$11,586.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,586.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,586.67
|
| Rate for Payer: Dean Health Medicaid |
$11,586.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,748.21
|
| Rate for Payer: Managed Health Services Medicaid |
$12,100.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,586.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,586.67
|
| Rate for Payer: United Healthcare Medicaid |
$11,586.67
|
|
|
VIRAL MENINGITIS
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00812
|
| Min. Negotiated Rate |
$100.79 |
| Max. Negotiated Rate |
$104.82 |
| Rate for Payer: Anthem Medicaid |
$100.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.79
|
| Rate for Payer: Dean Health Medicaid |
$100.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.79
|
| Rate for Payer: Managed Health Services Medicaid |
$104.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.79
|
| Rate for Payer: United Healthcare Medicaid |
$100.79
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$19,290.28
|
|
|
Service Code
|
APR-DRG 0514
|
| Min. Negotiated Rate |
$17,134.83 |
| Max. Negotiated Rate |
$19,290.28 |
| Rate for Payer: Anthem Medicaid |
$18,471.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,471.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,471.51
|
| Rate for Payer: Dean Health Medicaid |
$18,471.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,134.83
|
| Rate for Payer: Managed Health Services Medicaid |
$19,290.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,471.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,471.51
|
| Rate for Payer: United Healthcare Medicaid |
$18,471.51
|
|
|
VIRAL MENINGITIS
|
Facility
|
IP
|
$5,699.40
|
|
|
Service Code
|
APR-DRG 0511
|
| Min. Negotiated Rate |
$5,062.56 |
| Max. Negotiated Rate |
$5,699.40 |
| Rate for Payer: Anthem Medicaid |
$5,457.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,457.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,457.49
|
| Rate for Payer: Dean Health Medicaid |
$5,457.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,062.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5,699.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,457.49
|
| Rate for Payer: United Healthcare Medicaid |
$5,457.49
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$53,249.04
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$15,191.37 |
| Max. Negotiated Rate |
$53,249.04 |
| Rate for Payer: Aetna Managed Medicare |
$15,191.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,838.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,068.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,467.39
|
| Rate for Payer: Anthem Medicare Advantage |
$15,191.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,191.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,191.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,191.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,821.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,191.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,811.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,191.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,191.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,191.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,191.37
|
| Rate for Payer: NAPHCARE Commercial |
$22,787.06
|
| Rate for Payer: Quartz Medicare Advantage |
$15,191.37
|
| Rate for Payer: The Alliance Commercial |
$53,249.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,191.37
|
| Rate for Payer: United Healthcare PPO |
$30,215.54
|
| Rate for Payer: Wellcare Medicare |
$15,191.37
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$25,839.84
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$6,826.32 |
| Max. Negotiated Rate |
$25,839.84 |
| Rate for Payer: Aetna Managed Medicare |
$6,826.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,338.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,523.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,897.77
|
| Rate for Payer: Anthem Medicare Advantage |
$6,826.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,826.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,826.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,826.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,207.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,826.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,708.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,826.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,826.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,826.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,826.32
|
| Rate for Payer: NAPHCARE Commercial |
$10,239.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6,826.32
|
| Rate for Payer: The Alliance Commercial |
$25,839.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,826.32
|
| Rate for Payer: United Healthcare PPO |
$14,564.65
|
| Rate for Payer: Wellcare Medicare |
$6,826.32
|
|
|
Viral Respiratory, Rapid Culture w/ Reflex
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
3899563
|
|
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
|
|
|
Viral Respiratory, Rapid Culture w/ Reflex
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
3899563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| 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 |
$20.34
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| 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 |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$340.70
|
| Rate for Payer: HFN Commercial |
$355.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| 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 |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$80.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$89.51
|
|
|
Viral Respiratory, Rapid Culture w/ Reflex
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
3899563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| 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 |
$20.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.77
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| 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 |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| 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 |
$20.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| 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 |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$81.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: United Healthcare PPO |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: Wellcare Medicare |
$20.34
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
VIRTUOSAPH PLUS EVH SYSTEM VSP550EX
|
Facility
|
OP
|
$9,974.00
|
|
| Hospital Charge Code |
2967354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,904.43 |
| Max. Negotiated Rate |
$9,543.12 |
| Rate for Payer: Aetna Commercial |
$9,335.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,920.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,742.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,186.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,979.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.67
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,543.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.87
|
| Rate for Payer: Health EOS Commercial |
$9,231.93
|
| Rate for Payer: HFN Commercial |
$9,543.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,779.72
|
| Rate for Payer: Multiplan Commercial |
$8,298.37
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.78
|
| Rate for Payer: Preferred Network Access Commercial |
$9,543.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.75
|
| Rate for Payer: Quartz Commercial |
$6,742.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.78
|
| Rate for Payer: The Alliance Commercial |
$5,186.48
|
| Rate for Payer: WEA Trust Commercial |
$5,705.13
|
| Rate for Payer: WPS Commercial |
$7,682.97
|
|
|
VIRTUOSAPH PLUS EVH SYSTEM VSP550EX
|
Facility
|
IP
|
$9,974.00
|
|
| Hospital Charge Code |
2967354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,082.75 |
| Max. Negotiated Rate |
$9,543.12 |
| Rate for Payer: Aetna Commercial |
$9,335.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,920.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.67
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,543.12
|
| Rate for Payer: Health EOS Commercial |
$9,231.93
|
| Rate for Payer: HFN Commercial |
$9,543.12
|
| Rate for Payer: Multiplan Commercial |
$8,298.37
|
| Rate for Payer: Preferred Network Access Commercial |
$9,543.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.75
|
| Rate for Payer: Quartz Commercial |
$6,223.78
|
| Rate for Payer: WEA Trust Commercial |
$5,705.13
|
| Rate for Payer: WPS Commercial |
$7,682.97
|
|
|
Viscosity Serum Level
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
1043317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
