|
HIV-1 Genotype
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
4253986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,178.09 |
| Rate for Payer: Aetna Commercial |
$653.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$591.20
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$653.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$343.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$625.57
|
| Rate for Payer: HFN Commercial |
$653.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$549.95
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$653.07
|
| Rate for Payer: Quartz Beloit One Network |
$302.47
|
| Rate for Payer: Quartz Commercial |
$391.84
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,057.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$378.09
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
HIV-1 Genotype
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
4253986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$336.85 |
| Max. Negotiated Rate |
$632.44 |
| Rate for Payer: Aetna Commercial |
$618.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$591.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.34
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$632.44
|
| Rate for Payer: Health EOS Commercial |
$611.82
|
| Rate for Payer: HFN Commercial |
$632.44
|
| Rate for Payer: Multiplan Commercial |
$549.95
|
| Rate for Payer: Preferred Network Access Commercial |
$632.44
|
| Rate for Payer: Quartz Beloit One Network |
$336.85
|
| Rate for Payer: Quartz Commercial |
$412.46
|
| Rate for Payer: WEA Trust Commercial |
$378.09
|
| Rate for Payer: WPS Commercial |
$509.17
|
|
|
HIV-1 Genotype / 34949
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
4253870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.56 |
| Max. Negotiated Rate |
$542.26 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$135.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$508.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.04
|
| Rate for Payer: Anthem Medicare Advantage |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.56
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.56
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.56
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$203.35
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| Rate for Payer: Quartz Medicare Advantage |
$135.56
|
| Rate for Payer: The Alliance Commercial |
$542.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.56
|
| Rate for Payer: United Healthcare PPO |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: Wellcare Medicare |
$135.56
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
HIV-1 Genotype / 34949
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
4253870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
HIV-1 Genotype / 34949
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
4253870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.56 |
| Max. Negotiated Rate |
$596.48 |
| Rate for Payer: Aetna Commercial |
$434.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$135.56
|
| Rate for Payer: Anthem Medicare Advantage |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.56
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$434.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.56
|
| Rate for Payer: Health EOS Commercial |
$416.42
|
| Rate for Payer: HFN Commercial |
$434.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.56
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$203.35
|
| Rate for Payer: Preferred Network Access Commercial |
$434.72
|
| Rate for Payer: Quartz Beloit One Network |
$201.34
|
| Rate for Payer: Quartz Commercial |
$260.83
|
| Rate for Payer: Quartz Medicare Advantage |
$135.56
|
| Rate for Payer: The Alliance Commercial |
$535.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$596.48
|
|
|
HIV 1 Intergrase Genotype
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
5426839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$133.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$222.24
|
| Rate for Payer: Anthem Medicare Advantage |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$133.88
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$133.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$133.88
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$133.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$133.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$200.82
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$489.42
|
| Rate for Payer: Quartz Medicare Advantage |
$133.88
|
| Rate for Payer: The Alliance Commercial |
$535.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.88
|
| Rate for Payer: United Healthcare PPO |
$564.72
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: Wellcare Medicare |
$133.88
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
HIV 1 Intergrase Genotype
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
5426839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$368.95 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$451.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
HIV 1 Intergrase Genotype
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
5426839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$715.31 |
| Rate for Payer: Aetna Commercial |
$715.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$133.88
|
| Rate for Payer: Anthem Medicare Advantage |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$133.88
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$715.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.88
|
| Rate for Payer: Health EOS Commercial |
$685.19
|
| Rate for Payer: HFN Commercial |
$715.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$200.82
|
| Rate for Payer: Preferred Network Access Commercial |
$715.31
|
| Rate for Payer: Quartz Beloit One Network |
$331.30
|
| Rate for Payer: Quartz Commercial |
$429.19
|
| Rate for Payer: Quartz Medicare Advantage |
$133.88
|
| Rate for Payer: The Alliance Commercial |
$528.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.88
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$589.07
|
|
|
HIV 1 RNA PCR Quantitative
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
977981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
HIV 1 RNA PCR Quantitative
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
977981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$782.50 |
| Rate for Payer: Aetna Commercial |
$782.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$88.50
|
| Rate for Payer: Anthem Medicare Advantage |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.50
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$782.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$411.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.50
|
| Rate for Payer: Health EOS Commercial |
$749.55
|
| Rate for Payer: HFN Commercial |
$782.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$132.76
|
| Rate for Payer: Preferred Network Access Commercial |
$782.50
|
| Rate for Payer: Quartz Beloit One Network |
$362.42
|
| Rate for Payer: Quartz Commercial |
$469.50
|
| Rate for Payer: Quartz Medicare Advantage |
$88.50
|
| Rate for Payer: The Alliance Commercial |
$349.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$389.42
|
|
|
HIV 1 RNA PCR Quantitative
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
977981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$88.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.92
|
| Rate for Payer: Anthem Medicare Advantage |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.50
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.50
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$132.76
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$88.50
|
| Rate for Payer: The Alliance Commercial |
$354.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.50
|
| Rate for Payer: United Healthcare PPO |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: Wellcare Medicare |
$88.50
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
.HIV 1 RNA, QL TMA
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4558624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$210.91
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
.HIV 1 RNA, QL TMA
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4558624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$308.26 |
| Rate for Payer: Aetna Commercial |
$308.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$308.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$295.28
|
| Rate for Payer: HFN Commercial |
$308.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$308.26
|
| Rate for Payer: Quartz Beloit One Network |
$142.77
|
| Rate for Payer: Quartz Commercial |
$184.95
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
.HIV 1 RNA, QL TMA
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4558624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
HIV 2 Antibody
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
4495027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$14.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.06
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.06
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.06
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$21.09
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$14.06
|
| Rate for Payer: The Alliance Commercial |
$56.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.06
|
| Rate for Payer: United Healthcare PPO |
$63.18
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: Wellcare Medicare |
$14.06
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
HIV 2 Antibody
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
4495027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
HIV 2 Antibody
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
4495027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$14.06
|
| Rate for Payer: Anthem Medicare Advantage |
$14.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.06
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.06
|
| Rate for Payer: Health EOS Commercial |
$76.66
|
| Rate for Payer: HFN Commercial |
$80.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.06
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$21.09
|
| Rate for Payer: Preferred Network Access Commercial |
$80.03
|
| Rate for Payer: Quartz Beloit One Network |
$37.07
|
| Rate for Payer: Quartz Commercial |
$48.02
|
| Rate for Payer: Quartz Medicare Advantage |
$14.06
|
| Rate for Payer: The Alliance Commercial |
$55.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.06
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$61.87
|
|
|
HIV 2 DNA/RNA, Qualitative Real Time PCR
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
4056800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$257.09
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
HIV 2 DNA/RNA, Qualitative Real Time PCR
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
4056800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$278.51
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$321.36
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
HIV 2 DNA/RNA, Qualitative Real Time PCR
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
CPT 87538
|
| Hospital Charge Code |
4056800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$407.06 |
| Rate for Payer: Aetna Commercial |
$407.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$407.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$389.92
|
| Rate for Payer: HFN Commercial |
$407.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$407.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.53
|
| Rate for Payer: Quartz Commercial |
$244.23
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
HIV INFECTION
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00880
|
| 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
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$190,356.40
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$47,384.91 |
| Max. Negotiated Rate |
$190,356.40 |
| Rate for Payer: Aetna Managed Medicare |
$47,384.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133,561.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102,374.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97,262.07
|
| Rate for Payer: Anthem Medicare Advantage |
$47,384.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47,384.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47,384.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47,384.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107,969.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47,384.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139,376.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47,384.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47,384.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47,384.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47,384.91
|
| Rate for Payer: NAPHCARE Commercial |
$71,077.36
|
| Rate for Payer: Quartz Medicare Advantage |
$47,384.91
|
| Rate for Payer: The Alliance Commercial |
$190,356.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,384.91
|
| Rate for Payer: United Healthcare PPO |
$108,506.26
|
| Rate for Payer: Wellcare Medicare |
$47,384.91
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$77,187.76
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$20,704.51 |
| Max. Negotiated Rate |
$77,187.76 |
| Rate for Payer: Aetna Managed Medicare |
$20,704.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57,545.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44,108.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,905.97
|
| Rate for Payer: Anthem Medicare Advantage |
$20,704.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,704.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,704.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,704.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,519.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,704.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,761.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,704.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,704.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,704.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,704.51
|
| Rate for Payer: NAPHCARE Commercial |
$31,056.76
|
| Rate for Payer: Quartz Medicare Advantage |
$20,704.51
|
| Rate for Payer: The Alliance Commercial |
$77,187.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,704.51
|
| Rate for Payer: United Healthcare PPO |
$37,961.25
|
| Rate for Payer: Wellcare Medicare |
$20,704.51
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$12,012.58
|
|
|
Service Code
|
APR-DRG 8923
|
| Min. Negotiated Rate |
$10,670.33 |
| Max. Negotiated Rate |
$12,012.58 |
| Rate for Payer: Anthem Medicaid |
$11,502.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,502.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,502.71
|
| Rate for Payer: Dean Health Medicaid |
$11,502.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,670.33
|
| Rate for Payer: Managed Health Services Medicaid |
$12,012.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,502.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,502.71
|
| Rate for Payer: United Healthcare Medicaid |
$11,502.71
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$19,728.70
|
|
|
Service Code
|
APR-DRG 8924
|
| Min. Negotiated Rate |
$17,524.26 |
| Max. Negotiated Rate |
$19,728.70 |
| Rate for Payer: Anthem Medicaid |
$18,891.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,891.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,891.31
|
| Rate for Payer: Dean Health Medicaid |
$18,891.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,524.26
|
| Rate for Payer: Managed Health Services Medicaid |
$19,728.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,891.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,891.31
|
| Rate for Payer: United Healthcare Medicaid |
$18,891.31
|
|
