|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$8,417.58
|
|
|
Service Code
|
APR-DRG 8922
|
| Min. Negotiated Rate |
$7,477.02 |
| Max. Negotiated Rate |
$8,417.58 |
| Rate for Payer: Anthem Medicaid |
$8,060.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,060.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,060.29
|
| Rate for Payer: Dean Health Medicaid |
$8,060.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,477.02
|
| Rate for Payer: Managed Health Services Medicaid |
$8,417.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,060.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,060.29
|
| Rate for Payer: United Healthcare Medicaid |
$8,060.29
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$6,839.28
|
|
|
Service Code
|
APR-DRG 8921
|
| Min. Negotiated Rate |
$6,075.08 |
| Max. Negotiated Rate |
$6,839.28 |
| Rate for Payer: Anthem Medicaid |
$6,548.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,548.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,548.99
|
| Rate for Payer: Dean Health Medicaid |
$6,548.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,075.08
|
| Rate for Payer: Managed Health Services Medicaid |
$6,839.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,548.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,548.99
|
| Rate for Payer: United Healthcare Medicaid |
$6,548.99
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$38,027.60
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$10,424.15 |
| Max. Negotiated Rate |
$38,027.60 |
| Rate for Payer: Aetna Managed Medicare |
$10,424.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,255.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,657.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,576.41
|
| Rate for Payer: Anthem Medicare Advantage |
$10,424.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,424.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,424.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,424.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,841.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,424.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,647.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,424.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,424.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,424.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,424.15
|
| Rate for Payer: NAPHCARE Commercial |
$15,636.22
|
| Rate for Payer: Quartz Medicare Advantage |
$10,424.15
|
| Rate for Payer: The Alliance Commercial |
$38,027.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,424.15
|
| Rate for Payer: United Healthcare PPO |
$21,524.11
|
| Rate for Payer: Wellcare Medicare |
$10,424.15
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$80,972.32
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$22,608.34 |
| Max. Negotiated Rate |
$80,972.32 |
| Rate for Payer: Aetna Managed Medicare |
$22,608.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,970.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,266.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,856.00
|
| Rate for Payer: Anthem Medicare Advantage |
$22,608.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,608.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,608.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,608.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,904.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,608.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,146.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,608.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,608.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,608.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,608.34
|
| Rate for Payer: NAPHCARE Commercial |
$33,912.51
|
| Rate for Payer: Quartz Medicare Advantage |
$22,608.34
|
| Rate for Payer: The Alliance Commercial |
$80,972.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,608.34
|
| Rate for Payer: United Healthcare PPO |
$46,046.41
|
| Rate for Payer: Wellcare Medicare |
$22,608.34
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$23,705.76
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$7,419.83 |
| Max. Negotiated Rate |
$23,705.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,419.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,517.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,959.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,212.82
|
| Rate for Payer: Anthem Medicare Advantage |
$7,419.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,419.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,419.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,419.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,777.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,419.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,142.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,419.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,419.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,419.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,419.83
|
| Rate for Payer: NAPHCARE Commercial |
$11,129.74
|
| Rate for Payer: Quartz Medicare Advantage |
$7,419.83
|
| Rate for Payer: The Alliance Commercial |
$23,705.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,419.83
|
| Rate for Payer: United Healthcare PPO |
$13,345.80
|
| Rate for Payer: Wellcare Medicare |
$7,419.83
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 8901
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$29,987.62
|
|
|
Service Code
|
APR-DRG 8904
|
| Min. Negotiated Rate |
$26,636.88 |
| Max. Negotiated Rate |
$29,987.62 |
| Rate for Payer: Anthem Medicaid |
$28,714.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,714.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,714.80
|
| Rate for Payer: Dean Health Medicaid |
$28,714.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,636.88
|
| Rate for Payer: Managed Health Services Medicaid |
$29,987.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,714.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,714.80
|
| Rate for Payer: United Healthcare Medicaid |
$28,714.80
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$9,732.82
|
|
|
Service Code
|
APR-DRG 8902
|
| Min. Negotiated Rate |
$8,645.30 |
| Max. Negotiated Rate |
$9,732.82 |
| Rate for Payer: Anthem Medicaid |
$9,319.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,319.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,319.72
|
| Rate for Payer: Dean Health Medicaid |
$9,319.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,645.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9,732.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,319.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,319.72
|
| Rate for Payer: United Healthcare Medicaid |
$9,319.72
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$16,835.16
|
|
|
Service Code
|
APR-DRG 8903
|
| Min. Negotiated Rate |
$14,954.04 |
| Max. Negotiated Rate |
$16,835.16 |
| Rate for Payer: Anthem Medicaid |
$16,120.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,120.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,120.59
|
| Rate for Payer: Dean Health Medicaid |
$16,120.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,954.04
|
| Rate for Payer: Managed Health Services Medicaid |
$16,835.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,120.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,120.59
|
| Rate for Payer: United Healthcare Medicaid |
$16,120.59
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
|
IP
|
$6,400.87
|
|
|
Service Code
|
APR-DRG 8931
|
| Min. Negotiated Rate |
$5,685.65 |
| Max. Negotiated Rate |
$6,400.87 |
| Rate for Payer: Anthem Medicaid |
$6,129.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,129.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,129.18
|
| Rate for Payer: Dean Health Medicaid |
$6,129.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,685.65
|
| Rate for Payer: Managed Health Services Medicaid |
$6,400.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,129.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,129.18
|
| Rate for Payer: United Healthcare Medicaid |
$6,129.18
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 8932
|
| 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
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
|
IP
|
$11,048.07
|
|
|
Service Code
|
APR-DRG 8933
|
| Min. Negotiated Rate |
$9,813.59 |
| Max. Negotiated Rate |
$11,048.07 |
| Rate for Payer: Anthem Medicaid |
$10,579.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,579.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,579.14
|
| Rate for Payer: Dean Health Medicaid |
$10,579.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,813.59
|
| Rate for Payer: Managed Health Services Medicaid |
$11,048.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,579.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,579.14
|
| Rate for Payer: United Healthcare Medicaid |
$10,579.14
|
|
|
HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS
|
Facility
|
IP
|
$18,851.87
|
|
|
Service Code
|
APR-DRG 8934
|
| Min. Negotiated Rate |
$16,745.40 |
| Max. Negotiated Rate |
$18,851.87 |
| Rate for Payer: Anthem Medicaid |
$18,051.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,051.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,051.70
|
| Rate for Payer: Dean Health Medicaid |
$18,051.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,745.40
|
| Rate for Payer: Managed Health Services Medicaid |
$18,851.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,051.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,051.70
|
| Rate for Payer: United Healthcare Medicaid |
$18,051.70
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$7,453.06
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$6,620.28 |
| Max. Negotiated Rate |
$7,453.06 |
| Rate for Payer: Anthem Medicaid |
$7,136.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,136.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,136.72
|
| Rate for Payer: Dean Health Medicaid |
$7,136.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,620.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7,453.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,136.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,136.72
|
| Rate for Payer: United Healthcare Medicaid |
$7,136.72
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$9,820.51
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$8,723.19 |
| Max. Negotiated Rate |
$9,820.51 |
| Rate for Payer: Anthem Medicaid |
$9,403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,403.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,403.68
|
| Rate for Payer: Dean Health Medicaid |
$9,403.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,723.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9,820.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,403.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,403.68
|
| Rate for Payer: United Healthcare Medicaid |
$9,403.68
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$16,309.06
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$14,486.72 |
| Max. Negotiated Rate |
$16,309.06 |
| Rate for Payer: Anthem Medicaid |
$15,616.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,616.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,616.82
|
| Rate for Payer: Dean Health Medicaid |
$15,616.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,486.72
|
| Rate for Payer: Managed Health Services Medicaid |
$16,309.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,616.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,616.82
|
| Rate for Payer: United Healthcare Medicaid |
$15,616.82
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$39,487.76
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$10,444.82 |
| Max. Negotiated Rate |
$39,487.76 |
| Rate for Payer: Aetna Managed Medicare |
$10,444.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,658.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,199.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,141.05
|
| Rate for Payer: Anthem Medicare Advantage |
$10,444.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,444.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,444.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,444.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,358.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,444.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,718.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,444.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,444.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,444.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,444.82
|
| Rate for Payer: NAPHCARE Commercial |
$15,667.24
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.82
|
| Rate for Payer: The Alliance Commercial |
$39,487.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,444.82
|
| Rate for Payer: United Healthcare PPO |
$22,357.72
|
| Rate for Payer: Wellcare Medicare |
$10,444.82
|
|
|
HLA-A29 Determination
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
4514650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.30 |
| Max. Negotiated Rate |
$337.75 |
| Rate for Payer: Aetna Commercial |
$330.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Aetna Managed Medicare |
$77.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$289.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.32
|
| Rate for Payer: Anthem Medicare Advantage |
$77.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$77.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$77.30
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$337.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$77.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$77.30
|
| Rate for Payer: Health EOS Commercial |
$326.74
|
| Rate for Payer: HFN Commercial |
$337.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$77.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$77.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$77.30
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: NAPHCARE Commercial |
$115.95
|
| Rate for Payer: Preferred Network Access Commercial |
$337.75
|
| Rate for Payer: Quartz Beloit One Network |
$179.89
|
| Rate for Payer: Quartz Commercial |
$238.63
|
| Rate for Payer: Quartz Medicare Advantage |
$77.30
|
| Rate for Payer: The Alliance Commercial |
$309.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.30
|
| Rate for Payer: United Healthcare PPO |
$275.34
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: Wellcare Medicare |
$77.30
|
| Rate for Payer: WPS Commercial |
$271.92
|
|
|
HLA-A29 Determination
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
4514650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.30 |
| Max. Negotiated Rate |
$348.76 |
| Rate for Payer: Aetna Commercial |
$348.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Aetna Managed Medicare |
$77.30
|
| Rate for Payer: Anthem Medicare Advantage |
$77.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$77.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$77.30
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$348.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.30
|
| Rate for Payer: Health EOS Commercial |
$334.08
|
| Rate for Payer: HFN Commercial |
$348.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$272.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$77.30
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: NAPHCARE Commercial |
$115.95
|
| Rate for Payer: Preferred Network Access Commercial |
$348.76
|
| Rate for Payer: Quartz Beloit One Network |
$161.53
|
| Rate for Payer: Quartz Commercial |
$209.26
|
| Rate for Payer: Quartz Medicare Advantage |
$77.30
|
| Rate for Payer: The Alliance Commercial |
$305.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.30
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: WPS Commercial |
$340.13
|
|
|
HLA-A29 Determination
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
4514650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$337.75 |
| Rate for Payer: Aetna Commercial |
$330.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.57
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$337.75
|
| Rate for Payer: Health EOS Commercial |
$326.74
|
| Rate for Payer: HFN Commercial |
$337.75
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: Preferred Network Access Commercial |
$337.75
|
| Rate for Payer: Quartz Beloit One Network |
$179.89
|
| Rate for Payer: Quartz Commercial |
$220.27
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: WPS Commercial |
$271.92
|
|
|
HLA B 1502 Typing
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4318601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$398.99 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$260.21
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
HLA B 1502 Typing
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4318601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$706.78 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$662.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.32
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$176.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$176.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$281.89
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$706.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: United Healthcare PPO |
$325.26
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: Wellcare Medicare |
$176.70
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
HLA B 1502 Typing
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4318601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$777.46 |
| Rate for Payer: Aetna Commercial |
$412.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$412.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$394.65
|
| Rate for Payer: HFN Commercial |
$412.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$412.00
|
| Rate for Payer: Quartz Beloit One Network |
$190.82
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$697.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$777.46
|
|
|
HLA B-27 Antigen
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1039190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
