|
Allergen, Russian Thistle (w11) IgG
|
Professional
|
$51.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$7.82
|
| Rate for Payer: Anthem Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.82
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.82
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: Quartz Medicare Advantage |
$7.82
|
| Rate for Payer: The Alliance Commercial |
$30.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$34.41
|
|
|
Allergen, Russian Thistle (w11) IgG
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$7.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.82
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.82
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$11.73
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7.82
|
| Rate for Payer: The Alliance Commercial |
$204.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare PPO |
$38.25
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: Wellcare Medicare |
$7.82
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Allergen, Sage
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Sage
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Sage
|
Professional
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Salmon
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Allergen, Salmon
|
Professional
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Salmon
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$412.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Allergen, Saltwort, Russian Thistle
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Allergen, Saltwort, Russian Thistle
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$412.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Allergen, Saltwort, Russian Thistle
|
Professional
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
978107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Scallop
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Scallop
|
Professional
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Scallop
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Sesame Seed
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Sesame Seed
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Sesame Seed
|
Professional
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Sheep Sorrel
|
Professional
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4522743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Sheep Sorrel
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4522743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Sheep Sorrel
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4522743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Allergen, Shrimp
|
Professional
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977848
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Shrimp
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977848
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Allergen, Shrimp
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977848
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$412.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Allergen, Soybean
|
Professional
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergen, Soybean
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
