|
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
|
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
|
$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 & OTITIS MEDIA
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
EAPG 00562
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Anthem Medicaid |
$37.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.17
|
| Rate for Payer: Dean Health Medicaid |
$37.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37.17
|
| Rate for Payer: Managed Health Services Medicaid |
$38.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37.17
|
| Rate for Payer: United Healthcare Medicaid |
$37.17
|
|
|
INFECTIOUS AGENT ANTIBODY DETECTION BY ENZYME IMMUNOASSAY (EIA) TECHNIQUE, HIV-1 AND/OR HIV-2, SCREENING
|
Facility
|
OP
|
$81.41
|
|
|
Service Code
|
CPT G0432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$81.41 |
| Rate for Payer: Aetna Managed Medicare |
$20.35
|
| Rate for Payer: Anthem Medicare Advantage |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.35
|
| Rate for Payer: NAPHCARE Commercial |
$30.53
|
| Rate for Payer: Quartz Medicare Advantage |
$20.35
|
| Rate for Payer: The Alliance Commercial |
$81.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: Wellcare Medicare |
$20.35
|
|
|
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
|
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
|
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
|
$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
|
$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
|
$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
|
$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 AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECHNIQUE
|
Facility
|
OP
|
$145.97
|
|
|
Service Code
|
CPT 87640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
|
|
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT, AMPLIFIED PROBE TECHNIQUE
|
Facility
|
OP
|
$145.97
|
|
|
Service Code
|
CPT 87641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
|
|
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
|
$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
|
$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
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$138,561.28
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$38,327.56 |
| Max. Negotiated Rate |
$138,561.28 |
| Rate for Payer: Aetna Managed Medicare |
$38,327.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107,756.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82,594.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78,470.01
|
| Rate for Payer: Anthem Medicare Advantage |
$38,327.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,327.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,327.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,327.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87,108.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,327.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101,385.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,327.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,327.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,327.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,327.56
|
| Rate for Payer: NAPHCARE Commercial |
$57,491.34
|
| Rate for Payer: Quartz Medicare Advantage |
$38,327.56
|
| Rate for Payer: The Alliance Commercial |
$138,561.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,327.56
|
| Rate for Payer: United Healthcare PPO |
$78,930.14
|
| Rate for Payer: Wellcare Medicare |
$38,327.56
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,386.56
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$11,972.64 |
| Max. Negotiated Rate |
$47,386.56 |
| Rate for Payer: Aetna Managed Medicare |
$11,972.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,667.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,039.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,789.19
|
| Rate for Payer: Anthem Medicare Advantage |
$11,972.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,972.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,972.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,972.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,408.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,972.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,512.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,972.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,972.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,972.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,972.64
|
| Rate for Payer: NAPHCARE Commercial |
$17,958.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11,972.64
|
| Rate for Payer: The Alliance Commercial |
$47,386.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,972.64
|
| Rate for Payer: United Healthcare PPO |
$26,868.43
|
| Rate for Payer: Wellcare Medicare |
$11,972.64
|
|
|
Infed 50mg Charge
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$19.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.75
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.01
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$29.62
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.75
|
| Rate for Payer: The Alliance Commercial |
$54.31
|
| Rate for Payer: United Healthcare Medicaid |
$18.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.75
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$45.02
|
|
|
Infed 50mg Charge
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Infed 50mg Charge
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$19.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.01
|
| Rate for Payer: Anthem Medicare Advantage |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.75
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.75
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$29.62
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$19.75
|
| Rate for Payer: The Alliance Commercial |
$79.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.75
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$19.75
|
| Rate for Payer: WPS Commercial |
$45.02
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$45,152.64
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$11,863.11 |
| Max. Negotiated Rate |
$45,152.64 |
| Rate for Payer: Aetna Managed Medicare |
$11,863.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,355.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,800.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,561.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11,863.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,863.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,863.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,863.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,155.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,863.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,873.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,863.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,863.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,863.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,863.11
|
| Rate for Payer: NAPHCARE Commercial |
$17,794.67
|
| Rate for Payer: Quartz Medicare Advantage |
$11,863.11
|
| Rate for Payer: The Alliance Commercial |
$45,152.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,863.11
|
| Rate for Payer: United Healthcare PPO |
$25,592.74
|
| Rate for Payer: Wellcare Medicare |
$11,863.11
|
|
