|
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 |
$5.43 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| 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 |
$15.98
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| 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 |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| 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 |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2770800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$28.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$27.45
|
| Rate for Payer: HFN Commercial |
$28.65
|
| 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 |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$28.65
|
| Rate for Payer: Quartz Beloit One Network |
$13.27
|
| Rate for Payer: Quartz Commercial |
$17.19
|
| 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 |
$16.59
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Allergy Profile Region VII:MI,MN,WI
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
980017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$25.69 |
| Rate for Payer: Aetna Commercial |
$25.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| 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 |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$25.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$24.61
|
| Rate for Payer: HFN Commercial |
$25.69
|
| 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 |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$25.69
|
| Rate for Payer: Quartz Beloit One Network |
$11.90
|
| Rate for Payer: Quartz Commercial |
$15.41
|
| 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 |
$14.87
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
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 |
$5.43 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| 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 |
$15.98
|
| 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 |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| 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 |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| 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 |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
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 |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
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 |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
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 |
$5.43 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| 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 |
$14.33
|
| 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 |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| 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 |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| 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 |
$20.28
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
Allergy Sing/Multi Antigens Per Dose
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
1188810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$55.14 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$2.53
|
| Rate for Payer: Anthem Medicare Advantage |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.53
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.53
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$3.79
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2.53
|
| Rate for Payer: The Alliance Commercial |
$6.32
|
| Rate for Payer: United Healthcare Medicaid |
$10.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.53
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$10.11
|
|
|
ALLERGY TESTS
|
Facility
|
OP
|
$180.82
|
|
|
Service Code
|
EAPG 00116
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$180.82 |
| Rate for Payer: Anthem Medicaid |
$173.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$173.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.87
|
| Rate for Payer: Dean Health Medicaid |
$173.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$173.87
|
| Rate for Payer: Managed Health Services Medicaid |
$180.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$173.87
|
| Rate for Payer: United Healthcare Medicaid |
$173.87
|
|
|
ALLERGY THERAPY
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
EAPG 00458
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$23.59 |
| Rate for Payer: Anthem Medicaid |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.68
|
| Rate for Payer: Dean Health Medicaid |
$22.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.68
|
| Rate for Payer: Managed Health Services Medicaid |
$23.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.68
|
| Rate for Payer: United Healthcare Medicaid |
$22.68
|
|
|
Allery, Food Panel w/Rfxs
|
Facility
|
IP
|
$8.78
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6243354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.84
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$8.13
|
| Rate for Payer: HFN Commercial |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$7.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8.40
|
| Rate for Payer: Quartz Beloit One Network |
$4.47
|
| Rate for Payer: Quartz Commercial |
$5.48
|
| Rate for Payer: WEA Trust Commercial |
$5.02
|
| Rate for Payer: WPS Commercial |
$6.76
|
|
|
Allery, Food Panel w/Rfxs
|
Facility
|
OP
|
$8.78
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6243354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.85
|
| 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 |
$4.84
|
| 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 |
$2.63
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$8.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$8.13
|
| Rate for Payer: HFN Commercial |
$8.40
|
| 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 |
$7.30
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$8.40
|
| Rate for Payer: Quartz Beloit One Network |
$4.47
|
| Rate for Payer: Quartz Commercial |
$5.94
|
| 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 |
$6.85
|
| Rate for Payer: WEA Trust Commercial |
$5.02
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$6.76
|
|
|
Allery, Food Panel w/Rfxs
|
Professional
|
Both
|
$8.78
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6243354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.85
|
| 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 |
$2.63
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$8.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$8.31
|
| Rate for Payer: HFN Commercial |
$8.67
|
| 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 |
$7.30
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$8.67
|
| Rate for Payer: Quartz Beloit One Network |
$4.02
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| 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 |
$5.02
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$317,219.76
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$92,542.22 |
| Max. Negotiated Rate |
$317,219.76 |
| Rate for Payer: Aetna Managed Medicare |
$92,542.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262,220.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200,990.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190,953.86
|
| Rate for Payer: Anthem Medicare Advantage |
$92,542.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92,542.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92,542.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$92,542.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211,976.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$92,542.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92,542.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92,542.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$92,542.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$92,542.22
|
| Rate for Payer: NAPHCARE Commercial |
$138,813.32
|
| Rate for Payer: Quartz Medicare Advantage |
$92,542.22
|
| Rate for Payer: The Alliance Commercial |
$317,219.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92,542.22
|
| Rate for Payer: Wellcare Medicare |
$92,542.22
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$73,127.71
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$64,956.59 |
| Max. Negotiated Rate |
$73,127.71 |
| Rate for Payer: Anthem Medicaid |
$70,023.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$70,023.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70,023.81
|
| Rate for Payer: Dean Health Medicaid |
$70,023.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64,956.59
|
| Rate for Payer: Managed Health Services Medicaid |
$73,127.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$70,023.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70,023.81
|
| Rate for Payer: United Healthcare Medicaid |
$70,023.81
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$103,816.79
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$92,216.55 |
| Max. Negotiated Rate |
$103,816.79 |
| Rate for Payer: Anthem Medicaid |
$99,410.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$99,410.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99,410.30
|
| Rate for Payer: Dean Health Medicaid |
$99,410.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$92,216.55
|
| Rate for Payer: Managed Health Services Medicaid |
$103,816.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$99,410.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$99,410.30
|
| Rate for Payer: United Healthcare Medicaid |
$99,410.30
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$64,534.76
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$57,323.80 |
| Max. Negotiated Rate |
$64,534.76 |
| Rate for Payer: Anthem Medicaid |
$61,795.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$61,795.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61,795.59
|
| Rate for Payer: Dean Health Medicaid |
$61,795.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$57,323.80
|
| Rate for Payer: Managed Health Services Medicaid |
$64,534.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$61,795.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$61,795.59
|
| Rate for Payer: United Healthcare Medicaid |
$61,795.59
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$163,265.93
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$145,022.99 |
| Max. Negotiated Rate |
$163,265.93 |
| Rate for Payer: Anthem Medicaid |
$156,336.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$156,336.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156,336.13
|
| Rate for Payer: Dean Health Medicaid |
$156,336.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$145,022.99
|
| Rate for Payer: Managed Health Services Medicaid |
$163,265.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$156,336.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$156,336.13
|
| Rate for Payer: United Healthcare Medicaid |
$156,336.13
|
|
|
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 |
$130.97 |
| Max. Negotiated Rate |
$2,468.54 |
| Rate for Payer: Aetna Commercial |
$2,414.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,307.55
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,744.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,341.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,287.94
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna Commercial |
$2,468.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$2,388.05
|
| Rate for Payer: HFN Commercial |
$2,468.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$2,146.56
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.77
|
| Rate for Payer: Quartz Commercial |
$1,744.08
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$1,475.76
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$1,987.37
|
|
|
ALLOGRAFT AFFINITY FRESH AMNIOTIC MEMBRAINE (1.5CM X 1.5CM) 2.25CM AF-1150
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
5298717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.77 |
| Max. Negotiated Rate |
$2,468.54 |
| Rate for Payer: Aetna Commercial |
$2,414.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,307.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.10
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna Commercial |
$2,468.54
|
| Rate for Payer: Health EOS Commercial |
$2,388.05
|
| Rate for Payer: HFN Commercial |
$2,468.54
|
| Rate for Payer: Multiplan Commercial |
$2,146.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.77
|
| Rate for Payer: Quartz Commercial |
$1,609.92
|
| Rate for Payer: WEA Trust Commercial |
$1,475.76
|
| Rate for Payer: WPS Commercial |
$1,987.37
|
|
|
ALLOGRAFT AFFINITY FRESH AMNIOTIC MEMBRAINE (2.5CM X 2.5CM) 6.25CM AF-1250
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
5298718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$713.95 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$874.22
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
ALLOGRAFT AFFINITY FRESH AMNIOTIC MEMBRAINE (2.5CM X 2.5CM) 6.25CM AF-1250
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
5298718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$947.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$699.38
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$947.08
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
ALLOGRAFT BIOCLEANSE ANTERIOR TIBIALIS TENDON 8.5MM X 275MM FOLDED 443017
|
Facility
|
IP
|
$13,297.00
|
|
| Hospital Charge Code |
5583378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,776.15 |
| Max. Negotiated Rate |
$12,722.57 |
| Rate for Payer: Aetna Commercial |
$12,445.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,892.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,329.31
|
| Rate for Payer: Cash Price |
$3,989.10
|
| Rate for Payer: Cigna Commercial |
$12,722.57
|
| Rate for Payer: Health EOS Commercial |
$12,307.70
|
| Rate for Payer: HFN Commercial |
$12,722.57
|
| Rate for Payer: Multiplan Commercial |
$11,063.10
|
| Rate for Payer: Preferred Network Access Commercial |
$12,722.57
|
| Rate for Payer: Quartz Beloit One Network |
$6,776.15
|
| Rate for Payer: Quartz Commercial |
$8,297.33
|
| Rate for Payer: WEA Trust Commercial |
$7,605.88
|
| Rate for Payer: WPS Commercial |
$10,242.68
|
|
|
ALLOGRAFT BIOCLEANSE ANTERIOR TIBIALIS TENDON 8.5MM X 275MM FOLDED 443017
|
Facility
|
OP
|
$13,297.00
|
|
| Hospital Charge Code |
5583378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,872.09 |
| Max. Negotiated Rate |
$12,722.57 |
| Rate for Payer: Aetna Commercial |
$12,445.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,892.84
|
| Rate for Payer: Aetna Managed Medicare |
$3,872.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,988.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,914.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,637.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,329.31
|
| Rate for Payer: Cash Price |
$3,989.10
|
| Rate for Payer: Cigna Commercial |
$12,722.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,738.85
|
| Rate for Payer: Health EOS Commercial |
$12,307.70
|
| Rate for Payer: HFN Commercial |
$12,722.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,371.66
|
| Rate for Payer: Multiplan Commercial |
$11,063.10
|
| Rate for Payer: NAPHCARE Commercial |
$8,297.33
|
| Rate for Payer: Preferred Network Access Commercial |
$12,722.57
|
| Rate for Payer: Quartz Beloit One Network |
$6,776.15
|
| Rate for Payer: Quartz Commercial |
$8,988.77
|
| Rate for Payer: Quartz Medicare Advantage |
$8,297.33
|
| Rate for Payer: The Alliance Commercial |
$6,914.44
|
| Rate for Payer: WEA Trust Commercial |
$7,605.88
|
| Rate for Payer: WPS Commercial |
$10,242.68
|
|
|
ALLOGRAFT BIOCLEANSE SEMI-TENDINOSUS TENDON 453015
|
Facility
|
IP
|
$10,449.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4640836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,324.81 |
| Max. Negotiated Rate |
$9,997.60 |
| Rate for Payer: Aetna Commercial |
$9,780.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,345.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,759.49
|
| Rate for Payer: Cash Price |
$3,134.70
|
| Rate for Payer: Cigna Commercial |
$9,997.60
|
| Rate for Payer: Health EOS Commercial |
$9,671.59
|
| Rate for Payer: HFN Commercial |
$9,997.60
|
| Rate for Payer: Multiplan Commercial |
$8,693.57
|
| Rate for Payer: Preferred Network Access Commercial |
$9,997.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,324.81
|
| Rate for Payer: Quartz Commercial |
$6,520.18
|
| Rate for Payer: WEA Trust Commercial |
$5,976.83
|
| Rate for Payer: WPS Commercial |
$8,048.86
|
|
