|
Allergen, Common Ragweed
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Common Ragweed
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Allergen, Common Ragweed
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Allergen, Common Wasp (Yellow Jacket)
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Common Wasp (Yellow Jacket)
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Common Wasp (Yellow Jacket)
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Coriander/Cilantro
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4521290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Coriander/Cilantro
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4521290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Coriander/Cilantro
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4521290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Corn/Maize
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Corn/Maize
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Corn/Maize
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Corn Smut
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6172163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Corn Smut
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6172163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Corn Smut
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6172163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Cotton Seed
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3256216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Cotton Seed
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3256216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Allergen, Cotton Seed
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3256216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Cottonwood
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4522730
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Allergen, Cottonwood
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4522730
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Cottonwood
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4522730
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Allergen, Cow Dander
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergen, Cow Dander
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Allergen, Cow Dander
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Allergen, Crab
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
