|
HIV-1 Genotype / 34949
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
4253870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.60 |
| Max. Negotiated Rate |
$460.14 |
| Rate for Payer: Aetna Commercial |
$418.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$418.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$220.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.00
|
| Rate for Payer: Health EOS Commercial |
$400.40
|
| Rate for Payer: HFN Commercial |
$418.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.14
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Preferred Network Access Commercial |
$418.00
|
| Rate for Payer: Quartz Beloit One Network |
$193.60
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
HIV 1 Intergrase Genotype
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
5426839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.73 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$128.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.69
|
| Rate for Payer: Anthem Medicaid |
$133.02
|
| Rate for Payer: Anthem Medicare Advantage |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.73
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$128.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.15
|
| Rate for Payer: Dean Health Medicaid |
$133.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$128.73
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$133.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.73
|
| Rate for Payer: Managed Health Services Medicaid |
$138.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$128.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$128.73
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$193.10
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$133.02
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| Rate for Payer: Quartz Medicare Advantage |
$128.73
|
| Rate for Payer: The Alliance Commercial |
$514.92
|
| Rate for Payer: United Healthcare Medicaid |
$133.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.73
|
| Rate for Payer: United Healthcare PPO |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: Wellcare Medicare |
$128.73
|
| Rate for Payer: WMAP Medicaid |
$133.02
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
HIV 1 Intergrase Genotype
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
5426839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
HIV 1 Intergrase Genotype
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 87906
|
| Hospital Charge Code |
5426839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.56 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna Commercial |
$687.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$687.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$362.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.40
|
| Rate for Payer: Health EOS Commercial |
$658.84
|
| Rate for Payer: HFN Commercial |
$687.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.42
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.80
|
| Rate for Payer: Quartz Beloit One Network |
$318.56
|
| Rate for Payer: Quartz Commercial |
$412.68
|
| Rate for Payer: The Alliance Commercial |
$362.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
HIV 1 RNA PCR Quantitative
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
977981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$752.40 |
| Rate for Payer: Aetna Commercial |
$752.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$752.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$396.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.20
|
| Rate for Payer: Health EOS Commercial |
$720.72
|
| Rate for Payer: HFN Commercial |
$752.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.40
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Preferred Network Access Commercial |
$752.40
|
| Rate for Payer: Quartz Beloit One Network |
$348.48
|
| Rate for Payer: Quartz Commercial |
$451.44
|
| Rate for Payer: The Alliance Commercial |
$396.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
HIV 1 RNA PCR Quantitative
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
977981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$85.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Anthem Medicaid |
$87.93
|
| Rate for Payer: Anthem Medicare Advantage |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.10
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$85.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Dean Health Medicaid |
$87.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$85.10
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$87.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.10
|
| Rate for Payer: Managed Health Services Medicaid |
$91.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$85.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$85.10
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.65
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$85.10
|
| Rate for Payer: The Alliance Commercial |
$340.40
|
| Rate for Payer: United Healthcare Medicaid |
$87.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare PPO |
$594.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: Wellcare Medicare |
$85.10
|
| Rate for Payer: WMAP Medicaid |
$87.93
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
HIV 1 RNA PCR Quantitative
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
977981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
.HIV 1 RNA, QL TMA
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4558624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
.HIV 1 RNA, QL TMA
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4558624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.20
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
.HIV 1 RNA, QL TMA
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
4558624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
HIV 2 Antibody
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
4495027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna Commercial |
$76.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$76.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.60
|
| Rate for Payer: Health EOS Commercial |
$73.71
|
| Rate for Payer: HFN Commercial |
$76.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.73
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.95
|
| Rate for Payer: Quartz Beloit One Network |
$35.64
|
| Rate for Payer: Quartz Commercial |
$46.17
|
| Rate for Payer: The Alliance Commercial |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
HIV 2 Antibody
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
4495027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
HIV 2 Antibody
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
4495027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.44
|
| Rate for Payer: Anthem Medicaid |
$13.97
|
| Rate for Payer: Anthem Medicare Advantage |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.52
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Dean Health Medicaid |
$13.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.52
|
| Rate for Payer: Managed Health Services Medicaid |
$14.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$20.28
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$13.52
|
| Rate for Payer: The Alliance Commercial |
$54.08
|
| Rate for Payer: United Healthcare Medicaid |
$13.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.52
|
| Rate for Payer: United Healthcare PPO |
$60.75
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: Wellcare Medicare |
$13.52
|
| Rate for Payer: WMAP Medicaid |
$13.97
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
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 |
$35.09 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.56
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$267.80
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$309.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
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 |
$123.87 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$391.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.20
|
| Rate for Payer: Health EOS Commercial |
$374.92
|
| Rate for Payer: HFN Commercial |
$391.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.28
|
| Rate for Payer: Quartz Commercial |
$234.84
|
| Rate for Payer: The Alliance Commercial |
$206.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
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 |
$201.88 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$183,035.00
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$65,839.97 |
| Max. Negotiated Rate |
$183,035.00 |
| Rate for Payer: Aetna Managed Medicare |
$65,839.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144,132.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110,476.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104,959.86
|
| Rate for Payer: Anthem Medicare Advantage |
$65,839.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65,839.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65,839.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65,839.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116,515.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65,839.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134,015.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65,839.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65,839.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$65,839.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65,839.97
|
| Rate for Payer: NAPHCARE Commercial |
$98,759.96
|
| Rate for Payer: Quartz Medicare Advantage |
$65,839.97
|
| Rate for Payer: The Alliance Commercial |
$183,035.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65,839.97
|
| Rate for Payer: United Healthcare PPO |
$104,332.94
|
| Rate for Payer: Wellcare Medicare |
$65,839.97
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$74,219.00
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$26,697.41 |
| Max. Negotiated Rate |
$74,219.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,697.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,352.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,594.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,667.20
|
| Rate for Payer: Anthem Medicare Advantage |
$26,697.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,697.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,697.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,697.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,703.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,697.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,885.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,697.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,697.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,697.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,697.41
|
| Rate for Payer: NAPHCARE Commercial |
$40,046.12
|
| Rate for Payer: Quartz Medicare Advantage |
$26,697.41
|
| Rate for Payer: The Alliance Commercial |
$74,219.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,697.41
|
| Rate for Payer: United Healthcare PPO |
$36,501.20
|
| Rate for Payer: Wellcare Medicare |
$26,697.41
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$36,565.00
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$13,152.91 |
| Max. Negotiated Rate |
$36,565.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,152.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,152.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,152.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,152.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,152.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,152.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,584.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,152.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,152.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,152.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,152.91
|
| Rate for Payer: NAPHCARE Commercial |
$19,729.36
|
| Rate for Payer: Quartz Medicare Advantage |
$13,152.91
|
| Rate for Payer: The Alliance Commercial |
$36,565.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,152.91
|
| Rate for Payer: United Healthcare PPO |
$20,696.26
|
| Rate for Payer: Wellcare Medicare |
$13,152.91
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$77,858.00
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$28,006.62 |
| Max. Negotiated Rate |
$77,858.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,006.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61,261.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,956.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44,611.76
|
| Rate for Payer: Anthem Medicare Advantage |
$28,006.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,006.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,006.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,006.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49,523.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,006.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,871.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,006.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,006.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,006.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,006.62
|
| Rate for Payer: NAPHCARE Commercial |
$42,009.93
|
| Rate for Payer: Quartz Medicare Advantage |
$28,006.62
|
| Rate for Payer: The Alliance Commercial |
$77,858.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,006.62
|
| Rate for Payer: United Healthcare PPO |
$44,275.39
|
| Rate for Payer: Wellcare Medicare |
$28,006.62
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$22,794.00
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$8,199.12 |
| Max. Negotiated Rate |
$22,794.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,199.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,833.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,668.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,986.30
|
| Rate for Payer: Anthem Medicare Advantage |
$8,199.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,199.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,199.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,199.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,415.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,199.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,483.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,199.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,199.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,199.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,199.12
|
| Rate for Payer: NAPHCARE Commercial |
$12,298.68
|
| Rate for Payer: Quartz Medicare Advantage |
$8,199.12
|
| Rate for Payer: The Alliance Commercial |
$22,794.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,199.12
|
| Rate for Payer: United Healthcare PPO |
$12,832.50
|
| Rate for Payer: Wellcare Medicare |
$8,199.12
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$37,969.00
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$13,657.85 |
| Max. Negotiated Rate |
$37,969.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,657.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,791.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,835.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,694.76
|
| Rate for Payer: Anthem Medicare Advantage |
$13,657.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,657.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,657.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,657.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,083.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,657.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,613.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,657.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,657.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,657.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,657.85
|
| Rate for Payer: NAPHCARE Commercial |
$20,486.78
|
| Rate for Payer: Quartz Medicare Advantage |
$13,657.85
|
| Rate for Payer: The Alliance Commercial |
$37,969.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,657.85
|
| Rate for Payer: United Healthcare PPO |
$21,497.81
|
| Rate for Payer: Wellcare Medicare |
$13,657.85
|
|
|
HLA-A29 Determination
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
4514650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.33 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Aetna Managed Medicare |
$74.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$278.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.39
|
| Rate for Payer: Anthem Medicaid |
$76.81
|
| Rate for Payer: Anthem Medicare Advantage |
$74.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.33
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$74.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.54
|
| Rate for Payer: Dean Health Medicaid |
$76.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$74.33
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$76.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.33
|
| Rate for Payer: Managed Health Services Medicaid |
$79.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$74.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$74.33
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$111.50
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$76.81
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$229.45
|
| Rate for Payer: Quartz Medicare Advantage |
$74.33
|
| Rate for Payer: The Alliance Commercial |
$297.32
|
| Rate for Payer: United Healthcare Medicaid |
$76.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.33
|
| Rate for Payer: United Healthcare PPO |
$264.75
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: Wellcare Medicare |
$74.33
|
| Rate for Payer: WMAP Medicaid |
$76.81
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
HLA-A29 Determination
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
4514650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.32 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$335.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.80
|
| Rate for Payer: Health EOS Commercial |
$321.23
|
| Rate for Payer: HFN Commercial |
$335.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.38
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Preferred Network Access Commercial |
$335.35
|
| Rate for Payer: Quartz Beloit One Network |
$155.32
|
| Rate for Payer: Quartz Commercial |
$201.21
|
| Rate for Payer: The Alliance Commercial |
$176.50
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
HLA-A29 Determination
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
4514650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$211.80
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$211.80
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
