|
Allergy Panel, Region 3, Grasses
|
Facility
OP
|
$35.01
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4510604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$140.04 |
| Rate for Payer: Aetna Commercial |
$31.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.11
|
| 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 |
$18.56
|
| 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 |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.21
|
| 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 |
$31.16
|
| Rate for Payer: HFN Commercial |
$32.21
|
| 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 |
$28.01
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$32.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$140.04
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$26.26
|
| Rate for Payer: WEA Trust Commercial |
$19.26
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$25.93
|
|
|
Allergy Panel, Seafood Group
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3620168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| 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 |
$12.19
|
| 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 |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| 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 |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| 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 |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$17.25
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Allergy Panel, Seafood Group
|
Professional
|
$23.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3620168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| 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 |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| 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 |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| 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 |
$12.65
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergy Panel, Seafood Group
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3620168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Allergy Panel, Stinging Insect Group
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4075729
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| 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 |
$11.13
|
| 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 |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| 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 |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| 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 |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Allergy Panel, Stinging Insect Group
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4075729
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Allergy Panel, Stinging Insect Group
|
Professional
|
$21.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
4075729
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| 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 |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| 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 |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| 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 |
$11.55
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergy Profile Region VIII: IA,IL,MO
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| 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 |
$13.25
|
| 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 |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| 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 |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| 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 |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$18.75
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Allergy Profile Region VIII: IA,IL,MO
|
Professional
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| 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 |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$22.75
|
| 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 |
$20.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.75
|
| Rate for Payer: Quartz Beloit One Network |
$11.00
|
| Rate for Payer: Quartz Commercial |
$14.25
|
| 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 |
$13.75
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergy Profile Region VIII: IA,IL,MO
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Allergy Profile Region VIII: IA,IL,MO
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| 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 |
$15.37
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| 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 |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| 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 |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Allergy Profile Region VIII: IA,IL,MO
|
Professional
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| 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 |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| 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 |
$15.95
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergy Profile Region VIII: IA,IL,MO
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Professional
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| 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 |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| 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 |
$15.95
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| 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 |
$13.78
|
| 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 |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| 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 |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| 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 |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$19.50
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Professional
|
$26.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| 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 |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| 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 |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| 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 |
$14.30
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| 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 |
$15.37
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| 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 |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| 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 |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Allergy Sing/Multi Antigens Per Dose
|
Professional
|
$31.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
1188810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$53.02 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$7.78
|
| Rate for Payer: United Healthcare Medicaid |
$10.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$12.44
|
|
|
Allery, Food Panel w/Rfxs
|
Facility
IP
|
$8.78
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6243354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.65
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$8.08
|
| Rate for Payer: Health EOS Commercial |
$7.81
|
| Rate for Payer: HFN Commercial |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: NAPHCARE Commercial |
$5.27
|
| Rate for Payer: Preferred Network Access Commercial |
$8.08
|
| Rate for Payer: Quartz Beloit One Network |
$4.30
|
| Rate for Payer: Quartz Commercial |
$5.27
|
| Rate for Payer: WEA Trust Commercial |
$4.83
|
| Rate for Payer: WPS Commercial |
$6.50
|
|
|
Allery, Food Panel w/Rfxs
|
Professional
|
$8.78
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6243354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.55
|
| 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 |
$2.63
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$7.99
|
| 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 |
$7.02
|
| Rate for Payer: Preferred Network Access Commercial |
$8.34
|
| Rate for Payer: Quartz Beloit One Network |
$3.86
|
| Rate for Payer: Quartz Commercial |
$5.00
|
| 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 |
$4.83
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Allery, Food Panel w/Rfxs
|
Facility
OP
|
$8.78
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6243354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.55
|
| 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 |
$4.65
|
| 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 |
$2.63
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$8.08
|
| 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 |
$7.81
|
| Rate for Payer: HFN Commercial |
$8.08
|
| 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 |
$7.02
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$4.30
|
| Rate for Payer: Quartz Commercial |
$5.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$35.12
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$6.58
|
| Rate for Payer: WEA Trust Commercial |
$4.83
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$6.50
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$305,019.00
|
|
|
Service Code
|
MS-DRG 014
|
| Min. Negotiated Rate |
$109,719.22 |
| Max. Negotiated Rate |
$305,019.00 |
| Rate for Payer: Aetna Managed Medicare |
$109,719.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240,430.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184,288.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$175,085.88
|
| Rate for Payer: Anthem Medicare Advantage |
$109,719.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$109,719.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$109,719.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$109,719.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194,361.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$109,719.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223,487.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109,719.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$109,719.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$109,719.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$109,719.22
|
| Rate for Payer: NAPHCARE Commercial |
$164,578.83
|
| Rate for Payer: Quartz Medicare Advantage |
$109,719.22
|
| Rate for Payer: The Alliance Commercial |
$305,019.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109,719.22
|
| Rate for Payer: Wellcare Medicare |
$109,719.22
|
|
|
ALLOGRAFT AFFINITY FRESH AMNIOTIC MEMBRAINE (1.5CM X 1.5CM) 2.25CM AF-1150
|
Facility
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
5298717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.32 |
| Max. Negotiated Rate |
$2,373.60 |
| Rate for Payer: Aetna Commercial |
$2,322.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,218.80
|
| Rate for Payer: Aetna Managed Medicare |
$722.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,677.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,238.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,367.40
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna Commercial |
$2,373.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.57
|
| Rate for Payer: Health EOS Commercial |
$2,296.20
|
| Rate for Payer: HFN Commercial |
$2,373.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,935.00
|
| Rate for Payer: Multiplan Commercial |
$2,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,373.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,264.20
|
| Rate for Payer: Quartz Commercial |
$1,677.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,548.00
|
| Rate for Payer: The Alliance Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$1,419.00
|
| Rate for Payer: WPS Commercial |
$1,911.01
|
|
