|
Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510857
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.21
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$242.68
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$280.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
Indwelling/Continuous with Urometer - Urinary Catheter Type
|
Facility
|
OP
|
$477.00
|
|
| Hospital Charge Code |
2999939
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$456.39 |
| Rate for Payer: Aetna Commercial |
$446.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| Rate for Payer: Aetna Managed Medicare |
$138.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$322.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.92
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$456.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.61
|
| Rate for Payer: Health EOS Commercial |
$441.51
|
| Rate for Payer: HFN Commercial |
$456.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.06
|
| Rate for Payer: Multiplan Commercial |
$396.86
|
| Rate for Payer: NAPHCARE Commercial |
$297.65
|
| Rate for Payer: Preferred Network Access Commercial |
$456.39
|
| Rate for Payer: Quartz Beloit One Network |
$243.08
|
| Rate for Payer: Quartz Commercial |
$322.45
|
| Rate for Payer: Quartz Medicare Advantage |
$297.65
|
| Rate for Payer: The Alliance Commercial |
$248.04
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: WPS Commercial |
$367.43
|
|
|
Indwelling/Continuous with Urometer - Urinary Catheter Type
|
Facility
|
IP
|
$477.00
|
|
| Hospital Charge Code |
2999939
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$243.08 |
| Max. Negotiated Rate |
$456.39 |
| Rate for Payer: Aetna Commercial |
$446.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.92
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$456.39
|
| Rate for Payer: Health EOS Commercial |
$441.51
|
| Rate for Payer: HFN Commercial |
$456.39
|
| Rate for Payer: Multiplan Commercial |
$396.86
|
| Rate for Payer: Preferred Network Access Commercial |
$456.39
|
| Rate for Payer: Quartz Beloit One Network |
$243.08
|
| Rate for Payer: Quartz Commercial |
$297.65
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: WPS Commercial |
$367.43
|
|
|
Infant Hearing Screening
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
1188824
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Infant Hearing Screening
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
1188824
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare PPO |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$27,778.40
|
|
|
Service Code
|
MSDRG 758
|
| Min. Negotiated Rate |
$8,004.16 |
| Max. Negotiated Rate |
$27,778.40 |
| Rate for Payer: Aetna Managed Medicare |
$8,004.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,361.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,373.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,555.45
|
| Rate for Payer: Anthem Medicare Advantage |
$8,004.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,004.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,004.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,004.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,267.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,004.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,129.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,004.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,004.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,004.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,004.16
|
| Rate for Payer: NAPHCARE Commercial |
$12,006.24
|
| Rate for Payer: Quartz Medicare Advantage |
$8,004.16
|
| Rate for Payer: The Alliance Commercial |
$27,778.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,004.16
|
| Rate for Payer: United Healthcare PPO |
$15,671.41
|
| Rate for Payer: Wellcare Medicare |
$8,004.16
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$41,575.04
|
|
|
Service Code
|
MSDRG 757
|
| Min. Negotiated Rate |
$11,472.54 |
| Max. Negotiated Rate |
$41,575.04 |
| Rate for Payer: Aetna Managed Medicare |
$11,472.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,242.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,947.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,751.63
|
| Rate for Payer: Anthem Medicare Advantage |
$11,472.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,472.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,472.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,472.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,256.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,472.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,249.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,472.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,472.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,472.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,472.54
|
| Rate for Payer: NAPHCARE Commercial |
$17,208.81
|
| Rate for Payer: Quartz Medicare Advantage |
$11,472.54
|
| Rate for Payer: The Alliance Commercial |
$41,575.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,472.54
|
| Rate for Payer: United Healthcare PPO |
$23,549.74
|
| Rate for Payer: Wellcare Medicare |
$11,472.54
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$18,200.00
|
|
|
Service Code
|
MSDRG 759
|
| Min. Negotiated Rate |
$5,588.76 |
| Max. Negotiated Rate |
$18,200.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,588.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,479.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,098.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,544.02
|
| Rate for Payer: Anthem Medicare Advantage |
$5,588.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,588.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,588.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,588.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,704.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,588.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,104.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,588.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,588.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,588.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,588.76
|
| Rate for Payer: NAPHCARE Commercial |
$8,383.14
|
| Rate for Payer: Quartz Medicare Advantage |
$5,588.76
|
| Rate for Payer: The Alliance Commercial |
$18,200.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,588.76
|
| Rate for Payer: United Healthcare PPO |
$10,202.36
|
| Rate for Payer: Wellcare Medicare |
$5,588.76
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$4,910.25
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$4,361.59 |
| Max. Negotiated Rate |
$4,910.25 |
| Rate for Payer: Anthem Medicaid |
$4,701.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,701.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,701.84
|
| Rate for Payer: Dean Health Medicaid |
$4,701.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,361.59
|
| Rate for Payer: Managed Health Services Medicaid |
$4,910.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,701.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,701.84
|
| Rate for Payer: United Healthcare Medicaid |
$4,701.84
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$7,628.43
|
|
|
Service Code
|
APR-DRG 1133
|
| Min. Negotiated Rate |
$6,776.05 |
| Max. Negotiated Rate |
$7,628.43 |
| Rate for Payer: Anthem Medicaid |
$7,304.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,304.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,304.64
|
| Rate for Payer: Dean Health Medicaid |
$7,304.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,776.05
|
| Rate for Payer: Managed Health Services Medicaid |
$7,628.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,304.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,304.64
|
| Rate for Payer: United Healthcare Medicaid |
$7,304.64
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$3,419.64
|
|
|
Service Code
|
APR-DRG 1131
|
| Min. Negotiated Rate |
$3,037.54 |
| Max. Negotiated Rate |
$3,419.64 |
| Rate for Payer: Anthem Medicaid |
$3,274.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,274.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,274.49
|
| Rate for Payer: Dean Health Medicaid |
$3,274.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,037.54
|
| Rate for Payer: Managed Health Services Medicaid |
$3,419.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,274.49
|
| Rate for Payer: United Healthcare Medicaid |
$3,274.49
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$14,643.08
|
|
|
Service Code
|
APR-DRG 1134
|
| Min. Negotiated Rate |
$13,006.90 |
| Max. Negotiated Rate |
$14,643.08 |
| Rate for Payer: Anthem Medicaid |
$14,021.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,021.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,021.55
|
| Rate for Payer: Dean Health Medicaid |
$14,021.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,006.90
|
| Rate for Payer: Managed Health Services Medicaid |
$14,643.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,021.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,021.55
|
| Rate for Payer: United Healthcare Medicaid |
$14,021.55
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT & OTITIS MEDIA
|
Facility
|
OP
|
$83.86
|
|
|
Service Code
|
EAPG 00562
|
| Min. Negotiated Rate |
$80.63 |
| Max. Negotiated Rate |
$83.86 |
| Rate for Payer: Anthem Medicaid |
$80.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$80.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.63
|
| Rate for Payer: Dean Health Medicaid |
$80.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$80.63
|
| Rate for Payer: Managed Health Services Medicaid |
$83.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$80.63
|
| Rate for Payer: United Healthcare Medicaid |
$80.63
|
|
|
Infectious Agent Antigen, Influenza A/B POC
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2580835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Infectious Agent Antigen, Influenza A/B POC
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2580835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$17.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.57
|
| Rate for Payer: Anthem Medicare Advantage |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.21
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.21
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$68.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.21
|
| Rate for Payer: United Healthcare PPO |
$246.48
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: Wellcare Medicare |
$17.21
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Infectious Agent Antigen, Influenza A/B POC
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2580835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$17.21
|
| Rate for Payer: Anthem Medicare Advantage |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.21
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.21
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: Quartz Medicare Advantage |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$67.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.21
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$75.73
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
2600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3005542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$17.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.54
|
| Rate for Payer: Anthem Medicare Advantage |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.19
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.19
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$68.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.19
|
| Rate for Payer: United Healthcare PPO |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: Wellcare Medicare |
$17.19
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3005542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
Infectious Agent Antigen, Streptococcus Group A POC
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
2600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$17.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.54
|
| Rate for Payer: Anthem Medicare Advantage |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.19
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.19
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$68.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.19
|
| Rate for Payer: United Healthcare PPO |
$97.50
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: Wellcare Medicare |
$17.19
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$25,866.51
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$22,976.25 |
| Max. Negotiated Rate |
$25,866.51 |
| Rate for Payer: Anthem Medicaid |
$24,768.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$24,768.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24,768.61
|
| Rate for Payer: Dean Health Medicaid |
$24,768.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22,976.25
|
| Rate for Payer: Managed Health Services Medicaid |
$25,866.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,768.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24,768.61
|
| Rate for Payer: United Healthcare Medicaid |
$24,768.61
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$11,837.22
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$10,514.56 |
| Max. Negotiated Rate |
$11,837.22 |
| Rate for Payer: Anthem Medicaid |
$11,334.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,334.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,334.79
|
| Rate for Payer: Dean Health Medicaid |
$11,334.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,514.56
|
| Rate for Payer: Managed Health Services Medicaid |
$11,837.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,334.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,334.79
|
| Rate for Payer: United Healthcare Medicaid |
$11,334.79
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$39,808.13
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$35,360.06 |
| Max. Negotiated Rate |
$39,808.13 |
| Rate for Payer: Anthem Medicaid |
$38,118.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$38,118.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38,118.48
|
| Rate for Payer: Dean Health Medicaid |
$38,118.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35,360.06
|
| Rate for Payer: Managed Health Services Medicaid |
$39,808.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,118.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38,118.48
|
| Rate for Payer: United Healthcare Medicaid |
$38,118.48
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$17,448.94
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$15,499.23 |
| Max. Negotiated Rate |
$17,448.94 |
| Rate for Payer: Anthem Medicaid |
$16,708.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,708.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,708.32
|
| Rate for Payer: Dean Health Medicaid |
$16,708.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,499.23
|
| Rate for Payer: Managed Health Services Medicaid |
$17,448.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,708.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,708.32
|
| Rate for Payer: United Healthcare Medicaid |
$16,708.32
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$56,688.32
|
|
|
Service Code
|
MSDRG 854
|
| Min. Negotiated Rate |
$15,808.61 |
| Max. Negotiated Rate |
$56,688.32 |
| Rate for Payer: Aetna Managed Medicare |
$15,808.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,596.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,416.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,748.05
|
| Rate for Payer: Anthem Medicare Advantage |
$15,808.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,808.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,808.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,808.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,243.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,808.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,334.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,808.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,808.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,808.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,808.61
|
| Rate for Payer: NAPHCARE Commercial |
$23,712.92
|
| Rate for Payer: Quartz Medicare Advantage |
$15,808.61
|
| Rate for Payer: The Alliance Commercial |
$56,688.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,808.61
|
| Rate for Payer: United Healthcare PPO |
$32,179.59
|
| Rate for Payer: Wellcare Medicare |
$15,808.61
|
|
