|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
OP
|
$3,369.00
|
|
| Hospital Charge Code |
675693
|
| Min. Negotiated Rate |
$943.32 |
| Max. Negotiated Rate |
$13,476.00 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Aetna Managed Medicare |
$943.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,189.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,684.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,617.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,885.29
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,526.75
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,189.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,021.40
|
| Rate for Payer: The Alliance Commercial |
$13,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Professional
|
Both
|
$3,369.00
|
|
| Hospital Charge Code |
675693
|
| Min. Negotiated Rate |
$1,482.36 |
| Max. Negotiated Rate |
$3,200.55 |
| Rate for Payer: Aetna Commercial |
$3,200.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,200.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,684.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,021.40
|
| Rate for Payer: Health EOS Commercial |
$3,065.79
|
| Rate for Payer: HFN Commercial |
$3,200.55
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,200.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,482.36
|
| Rate for Payer: Quartz Commercial |
$1,920.33
|
| Rate for Payer: The Alliance Commercial |
$1,684.50
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
IP
|
$3,369.00
|
|
| Hospital Charge Code |
675693
|
| Min. Negotiated Rate |
$1,650.81 |
| Max. Negotiated Rate |
$3,099.48 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,021.40
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
675691
|
| Min. Negotiated Rate |
$1,482.36 |
| Max. Negotiated Rate |
$3,200.55 |
| Rate for Payer: Aetna Commercial |
$3,200.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,200.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,684.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,021.40
|
| Rate for Payer: Health EOS Commercial |
$3,065.79
|
| Rate for Payer: HFN Commercial |
$3,200.55
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,200.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,482.36
|
| Rate for Payer: Quartz Commercial |
$1,920.33
|
| Rate for Payer: The Alliance Commercial |
$1,684.50
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Professional
|
Both
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586807
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,541.76 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Aetna Commercial |
$3,328.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,328.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,752.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.40
|
| Rate for Payer: Health EOS Commercial |
$3,188.64
|
| Rate for Payer: HFN Commercial |
$3,328.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,250.16
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.76
|
| Rate for Payer: Quartz Commercial |
$1,997.28
|
| Rate for Payer: The Alliance Commercial |
$1,752.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586807
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,153.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,223.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,118.56
|
| Rate for Payer: HFN Commercial |
$3,223.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.96
|
| Rate for Payer: Quartz Commercial |
$2,277.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
675691
|
| Min. Negotiated Rate |
$1,650.81 |
| Max. Negotiated Rate |
$3,099.48 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,021.40
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586807
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,716.96 |
| Max. Negotiated Rate |
$3,223.68 |
| Rate for Payer: Aetna Commercial |
$3,153.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.12
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,223.68
|
| Rate for Payer: Health EOS Commercial |
$3,118.56
|
| Rate for Payer: HFN Commercial |
$3,223.68
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.96
|
| Rate for Payer: Quartz Commercial |
$2,102.40
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
675691
|
| Min. Negotiated Rate |
$943.32 |
| Max. Negotiated Rate |
$13,476.00 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Aetna Managed Medicare |
$943.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,189.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,684.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,617.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,885.29
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,526.75
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,189.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,021.40
|
| Rate for Payer: The Alliance Commercial |
$13,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
OP
|
$3,369.00
|
|
| Hospital Charge Code |
675689
|
| Min. Negotiated Rate |
$943.32 |
| Max. Negotiated Rate |
$13,476.00 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Aetna Managed Medicare |
$943.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,189.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,684.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,617.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,885.29
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,526.75
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,189.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,021.40
|
| Rate for Payer: The Alliance Commercial |
$13,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Professional
|
Both
|
$3,369.00
|
|
| Hospital Charge Code |
675689
|
| Min. Negotiated Rate |
$1,482.36 |
| Max. Negotiated Rate |
$3,200.55 |
| Rate for Payer: Aetna Commercial |
$3,200.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,200.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,684.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,021.40
|
| Rate for Payer: Health EOS Commercial |
$3,065.79
|
| Rate for Payer: HFN Commercial |
$3,200.55
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,200.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,482.36
|
| Rate for Payer: Quartz Commercial |
$1,920.33
|
| Rate for Payer: The Alliance Commercial |
$1,684.50
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
IP
|
$3,369.00
|
|
| Hospital Charge Code |
675689
|
| Min. Negotiated Rate |
$1,650.81 |
| Max. Negotiated Rate |
$3,099.48 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,021.40
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586809
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,716.96 |
| Max. Negotiated Rate |
$3,223.68 |
| Rate for Payer: Aetna Commercial |
$3,153.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.12
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,223.68
|
| Rate for Payer: Health EOS Commercial |
$3,118.56
|
| Rate for Payer: HFN Commercial |
$3,223.68
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.96
|
| Rate for Payer: Quartz Commercial |
$2,102.40
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Professional
|
Both
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586809
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,541.76 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Aetna Commercial |
$3,328.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,328.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,752.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.40
|
| Rate for Payer: Health EOS Commercial |
$3,188.64
|
| Rate for Payer: HFN Commercial |
$3,328.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,250.16
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.76
|
| Rate for Payer: Quartz Commercial |
$1,997.28
|
| Rate for Payer: The Alliance Commercial |
$1,752.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586809
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,153.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,223.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,118.56
|
| Rate for Payer: HFN Commercial |
$3,223.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.96
|
| Rate for Payer: Quartz Commercial |
$2,277.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
IP
|
$2,815.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
625650
|
| Min. Negotiated Rate |
$1,379.35 |
| Max. Negotiated Rate |
$2,589.80 |
| Rate for Payer: Aetna Commercial |
$2,533.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.95
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cigna Commercial |
$2,589.80
|
| Rate for Payer: Health EOS Commercial |
$2,505.35
|
| Rate for Payer: HFN Commercial |
$2,589.80
|
| Rate for Payer: Multiplan Commercial |
$2,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,689.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,589.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,379.35
|
| Rate for Payer: Quartz Commercial |
$1,689.00
|
| Rate for Payer: WEA Trust Commercial |
$1,548.25
|
| Rate for Payer: WPS Commercial |
$2,085.07
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
IP
|
$2,928.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
2586813
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,434.72 |
| Max. Negotiated Rate |
$2,693.76 |
| Rate for Payer: Aetna Commercial |
$2,635.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.84
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cigna Commercial |
$2,693.76
|
| Rate for Payer: Health EOS Commercial |
$2,605.92
|
| Rate for Payer: HFN Commercial |
$2,693.76
|
| Rate for Payer: Multiplan Commercial |
$2,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,756.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,693.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.72
|
| Rate for Payer: Quartz Commercial |
$1,756.80
|
| Rate for Payer: WEA Trust Commercial |
$1,610.40
|
| Rate for Payer: WPS Commercial |
$2,168.77
|
|
|
NM Acute Venous Thrombosis Imaging
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
625650
|
| Min. Negotiated Rate |
$1,069.77 |
| Max. Negotiated Rate |
$2,674.25 |
| Rate for Payer: Aetna Commercial |
$2,674.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.90
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cigna Commercial |
$2,674.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,407.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,689.00
|
| Rate for Payer: Health EOS Commercial |
$2,561.65
|
| Rate for Payer: HFN Commercial |
$2,674.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,069.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,069.77
|
| Rate for Payer: Multiplan Commercial |
$2,252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,674.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,238.60
|
| Rate for Payer: Quartz Commercial |
$1,604.55
|
| Rate for Payer: The Alliance Commercial |
$1,407.50
|
| Rate for Payer: WEA Trust Commercial |
$1,548.25
|
| Rate for Payer: WPS Commercial |
$2,085.07
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
OP
|
$2,815.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
625650
|
| Min. Negotiated Rate |
$1,351.20 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$2,533.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,829.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,407.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,351.20
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cigna Commercial |
$2,589.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,575.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$2,505.35
|
| Rate for Payer: HFN Commercial |
$2,589.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$2,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,589.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,379.35
|
| Rate for Payer: Quartz Commercial |
$1,829.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: WEA Trust Commercial |
$1,548.25
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,085.07
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
OP
|
$2,928.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
2586813
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$2,635.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cigna Commercial |
$2,693.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,638.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$2,605.92
|
| Rate for Payer: HFN Commercial |
$2,693.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$2,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,693.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.72
|
| Rate for Payer: Quartz Commercial |
$1,903.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.40
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,168.77
|
|
|
NM Acute Venous Thrombosis Imaging
|
Professional
|
Both
|
$2,928.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
2586813
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,069.77 |
| Max. Negotiated Rate |
$2,781.60 |
| Rate for Payer: Aetna Commercial |
$2,781.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.08
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cigna Commercial |
$2,781.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,464.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.80
|
| Rate for Payer: Health EOS Commercial |
$2,664.48
|
| Rate for Payer: HFN Commercial |
$2,781.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,069.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,069.77
|
| Rate for Payer: Multiplan Commercial |
$2,342.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,781.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,288.32
|
| Rate for Payer: Quartz Commercial |
$1,668.96
|
| Rate for Payer: The Alliance Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.40
|
| Rate for Payer: WPS Commercial |
$2,168.77
|
|
|
NM Bone Imaging Limited
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2586817
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$939.82 |
| Max. Negotiated Rate |
$1,764.56 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,150.80
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
NM Bone Imaging Limited
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2586817
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,246.70
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
NM Bone Imaging Limited
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
627640
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,696.48 |
| Rate for Payer: Aetna Commercial |
$1,659.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,585.84
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,198.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$922.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$885.12
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,696.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,031.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,641.16
|
| Rate for Payer: HFN Commercial |
$1,696.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,696.48
|
| Rate for Payer: Quartz Beloit One Network |
$903.56
|
| Rate for Payer: Quartz Commercial |
$1,198.60
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,014.20
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,365.85
|
|
|
NM Bone Imaging Limited
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
627640
|
| Min. Negotiated Rate |
$903.56 |
| Max. Negotiated Rate |
$1,696.48 |
| Rate for Payer: Aetna Commercial |
$1,659.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,585.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.32
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,696.48
|
| Rate for Payer: Health EOS Commercial |
$1,641.16
|
| Rate for Payer: HFN Commercial |
$1,696.48
|
| Rate for Payer: Multiplan Commercial |
$1,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,696.48
|
| Rate for Payer: Quartz Beloit One Network |
$903.56
|
| Rate for Payer: Quartz Commercial |
$1,106.40
|
| Rate for Payer: WEA Trust Commercial |
$1,014.20
|
| Rate for Payer: WPS Commercial |
$1,365.85
|
|
