|
NM Bone Imaging Limited
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
627640
|
| Min. Negotiated Rate |
$782.42 |
| Max. Negotiated Rate |
$1,751.80 |
| Rate for Payer: Aetna Commercial |
$1,751.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,585.84
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,751.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$922.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,106.40
|
| Rate for Payer: Health EOS Commercial |
$1,678.04
|
| Rate for Payer: HFN Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.42
|
| Rate for Payer: Multiplan Commercial |
$1,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.80
|
| Rate for Payer: Quartz Beloit One Network |
$811.36
|
| Rate for Payer: Quartz Commercial |
$1,051.08
|
| Rate for Payer: The Alliance Commercial |
$922.00
|
| Rate for Payer: WEA Trust Commercial |
$1,014.20
|
| Rate for Payer: WPS Commercial |
$1,365.85
|
|
|
NM Bone Imaging Limited
|
Professional
|
Both
|
$1,918.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2586817
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$782.42 |
| Max. Negotiated Rate |
$1,822.10 |
| Rate for Payer: Aetna Commercial |
$1,822.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| 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 |
$1,822.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,150.80
|
| Rate for Payer: Health EOS Commercial |
$1,745.38
|
| Rate for Payer: HFN Commercial |
$1,822.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.42
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,822.10
|
| Rate for Payer: Quartz Beloit One Network |
$843.92
|
| Rate for Payer: Quartz Commercial |
$1,093.26
|
| Rate for Payer: The Alliance Commercial |
$959.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
627644
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,452.72 |
| Rate for Payer: Aetna Commercial |
$2,399.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.76
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.68
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.98
|
| 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 |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,452.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,372.74
|
| Rate for Payer: HFN Commercial |
$2,452.72
|
| 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 |
$2,132.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.34
|
| Rate for Payer: Quartz Commercial |
$1,732.90
|
| 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 |
$1,466.30
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,974.71
|
|
|
NM Bone Imaging Whole Body
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
627644
|
| Min. Negotiated Rate |
$1,020.84 |
| Max. Negotiated Rate |
$2,532.70 |
| Rate for Payer: Aetna Commercial |
$2,532.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.76
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,532.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,333.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,599.60
|
| Rate for Payer: Health EOS Commercial |
$2,426.06
|
| Rate for Payer: HFN Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,020.84
|
| Rate for Payer: Multiplan Commercial |
$2,132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,532.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.04
|
| Rate for Payer: Quartz Commercial |
$1,519.62
|
| Rate for Payer: The Alliance Commercial |
$1,333.00
|
| Rate for Payer: WEA Trust Commercial |
$1,466.30
|
| Rate for Payer: WPS Commercial |
$1,974.71
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
627644
|
| Min. Negotiated Rate |
$1,306.34 |
| Max. Negotiated Rate |
$2,452.72 |
| Rate for Payer: Aetna Commercial |
$2,399.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.98
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,372.74
|
| Rate for Payer: HFN Commercial |
$2,452.72
|
| Rate for Payer: Multiplan Commercial |
$2,132.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.34
|
| Rate for Payer: Quartz Commercial |
$1,599.60
|
| Rate for Payer: WEA Trust Commercial |
$1,466.30
|
| Rate for Payer: WPS Commercial |
$1,974.71
|
|
|
NM Bone Imaging Whole Body
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2586821
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,020.84 |
| Max. Negotiated Rate |
$2,734.10 |
| Rate for Payer: Aetna Commercial |
$2,734.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,475.08
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$2,734.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,439.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,726.80
|
| Rate for Payer: Health EOS Commercial |
$2,618.98
|
| Rate for Payer: HFN Commercial |
$2,734.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,020.84
|
| Rate for Payer: Multiplan Commercial |
$2,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,734.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.32
|
| Rate for Payer: Quartz Commercial |
$1,640.46
|
| Rate for Payer: The Alliance Commercial |
$1,439.00
|
| Rate for Payer: WEA Trust Commercial |
$1,582.90
|
| Rate for Payer: WPS Commercial |
$2,131.73
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
IP
|
$2,878.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2586821
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,410.22 |
| Max. Negotiated Rate |
$2,647.76 |
| Rate for Payer: Aetna Commercial |
$2,590.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,475.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,525.34
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$2,647.76
|
| Rate for Payer: Health EOS Commercial |
$2,561.42
|
| Rate for Payer: HFN Commercial |
$2,647.76
|
| Rate for Payer: Multiplan Commercial |
$2,302.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,647.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,410.22
|
| Rate for Payer: Quartz Commercial |
$1,726.80
|
| Rate for Payer: WEA Trust Commercial |
$1,582.90
|
| Rate for Payer: WPS Commercial |
$2,131.73
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
OP
|
$2,878.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2586821
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,647.76 |
| Rate for Payer: Aetna Commercial |
$2,590.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,475.08
|
| 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 |
$1,525.34
|
| 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 |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$2,647.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,610.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,561.42
|
| Rate for Payer: HFN Commercial |
$2,647.76
|
| 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 |
$2,302.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,647.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,410.22
|
| Rate for Payer: Quartz Commercial |
$1,870.70
|
| 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 |
$1,582.90
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,131.73
|
|
|
NM Bone Three Phase Study
|
Professional
|
Both
|
$2,814.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2586831
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,181.31 |
| Max. Negotiated Rate |
$2,673.30 |
| Rate for Payer: Aetna Commercial |
$2,673.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.04
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,673.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,407.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.40
|
| Rate for Payer: Health EOS Commercial |
$2,560.74
|
| Rate for Payer: HFN Commercial |
$2,673.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,181.31
|
| Rate for Payer: Multiplan Commercial |
$2,251.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,673.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,238.16
|
| Rate for Payer: Quartz Commercial |
$1,603.98
|
| Rate for Payer: The Alliance Commercial |
$1,407.00
|
| Rate for Payer: WEA Trust Commercial |
$1,547.70
|
| Rate for Payer: WPS Commercial |
$2,084.33
|
|
|
NM Bone Three Phase Study
|
Professional
|
Both
|
$2,606.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
627664
|
| Min. Negotiated Rate |
$1,146.64 |
| Max. Negotiated Rate |
$2,475.70 |
| Rate for Payer: Aetna Commercial |
$2,475.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.16
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,475.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,563.60
|
| Rate for Payer: Health EOS Commercial |
$2,371.46
|
| Rate for Payer: HFN Commercial |
$2,475.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,181.31
|
| Rate for Payer: Multiplan Commercial |
$2,084.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,475.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.64
|
| Rate for Payer: Quartz Commercial |
$1,485.42
|
| Rate for Payer: The Alliance Commercial |
$1,303.00
|
| Rate for Payer: WEA Trust Commercial |
$1,433.30
|
| Rate for Payer: WPS Commercial |
$1,930.26
|
|
|
NM Bone Three Phase Study
|
Facility
|
OP
|
$2,606.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
627664
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,397.52 |
| Rate for Payer: Aetna Commercial |
$2,345.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.16
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,693.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,303.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,250.88
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.18
|
| 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 |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,397.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,458.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,319.34
|
| Rate for Payer: HFN Commercial |
$2,397.52
|
| 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 |
$2,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.94
|
| Rate for Payer: Quartz Commercial |
$1,693.90
|
| 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 |
$1,433.30
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,930.26
|
|
|
NM Bone Three Phase Study
|
Facility
|
IP
|
$2,606.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
627664
|
| Min. Negotiated Rate |
$1,276.94 |
| Max. Negotiated Rate |
$2,397.52 |
| Rate for Payer: Aetna Commercial |
$2,345.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.18
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,397.52
|
| Rate for Payer: Health EOS Commercial |
$2,319.34
|
| Rate for Payer: HFN Commercial |
$2,397.52
|
| Rate for Payer: Multiplan Commercial |
$2,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,563.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.94
|
| Rate for Payer: Quartz Commercial |
$1,563.60
|
| Rate for Payer: WEA Trust Commercial |
$1,433.30
|
| Rate for Payer: WPS Commercial |
$1,930.26
|
|
|
NM Bone Three Phase Study
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2586831
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,378.86 |
| Max. Negotiated Rate |
$2,588.88 |
| Rate for Payer: Aetna Commercial |
$2,532.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.42
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,588.88
|
| Rate for Payer: Health EOS Commercial |
$2,504.46
|
| Rate for Payer: HFN Commercial |
$2,588.88
|
| Rate for Payer: Multiplan Commercial |
$2,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,688.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,588.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.86
|
| Rate for Payer: Quartz Commercial |
$1,688.40
|
| Rate for Payer: WEA Trust Commercial |
$1,547.70
|
| Rate for Payer: WPS Commercial |
$2,084.33
|
|
|
NM Bone Three Phase Study
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2586831
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,588.88 |
| Rate for Payer: Aetna Commercial |
$2,532.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.04
|
| 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 |
$1,491.42
|
| 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 |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,588.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,504.46
|
| Rate for Payer: HFN Commercial |
$2,588.88
|
| 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 |
$2,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,588.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.86
|
| Rate for Payer: Quartz Commercial |
$1,829.10
|
| 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 |
$1,547.70
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,084.33
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
IP
|
$2,076.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
631503
|
| Min. Negotiated Rate |
$1,017.24 |
| Max. Negotiated Rate |
$1,909.92 |
| Rate for Payer: Aetna Commercial |
$1,868.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,785.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.28
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$1,909.92
|
| Rate for Payer: Health EOS Commercial |
$1,847.64
|
| Rate for Payer: HFN Commercial |
$1,909.92
|
| Rate for Payer: Multiplan Commercial |
$1,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,245.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,909.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.24
|
| Rate for Payer: Quartz Commercial |
$1,245.60
|
| Rate for Payer: WEA Trust Commercial |
$1,141.80
|
| Rate for Payer: WPS Commercial |
$1,537.69
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
2586833
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,017.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.12
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,003.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,602.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.58
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,062.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,254.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$1,995.38
|
| Rate for Payer: HFN Commercial |
$2,062.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.58
|
| Rate for Payer: Quartz Commercial |
$1,457.30
|
| Rate for Payer: Quartz Medicare Advantage |
$534.24
|
| Rate for Payer: The Alliance Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.24
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,233.10
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,660.65
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Professional
|
Both
|
$2,076.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
631503
|
| Min. Negotiated Rate |
$913.44 |
| Max. Negotiated Rate |
$1,972.20 |
| Rate for Payer: Aetna Commercial |
$1,972.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,785.36
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$1,972.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,038.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,245.60
|
| Rate for Payer: Health EOS Commercial |
$1,889.16
|
| Rate for Payer: HFN Commercial |
$1,972.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,129.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,129.85
|
| Rate for Payer: Multiplan Commercial |
$1,660.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,972.20
|
| Rate for Payer: Quartz Beloit One Network |
$913.44
|
| Rate for Payer: Quartz Commercial |
$1,183.32
|
| Rate for Payer: The Alliance Commercial |
$1,038.00
|
| Rate for Payer: WEA Trust Commercial |
$1,141.80
|
| Rate for Payer: WPS Commercial |
$1,537.69
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
2586833
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,098.58 |
| Max. Negotiated Rate |
$2,062.64 |
| Rate for Payer: Aetna Commercial |
$2,017.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.26
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,062.64
|
| Rate for Payer: Health EOS Commercial |
$1,995.38
|
| Rate for Payer: HFN Commercial |
$2,062.64
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,345.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.58
|
| Rate for Payer: Quartz Commercial |
$1,345.20
|
| Rate for Payer: WEA Trust Commercial |
$1,233.10
|
| Rate for Payer: WPS Commercial |
$1,660.65
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
2586833
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$986.48 |
| Max. Negotiated Rate |
$2,129.90 |
| Rate for Payer: Aetna Commercial |
$2,129.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.12
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,129.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,121.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,345.20
|
| Rate for Payer: Health EOS Commercial |
$2,040.22
|
| Rate for Payer: HFN Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,129.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,129.85
|
| Rate for Payer: Multiplan Commercial |
$1,793.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,129.90
|
| Rate for Payer: Quartz Beloit One Network |
$986.48
|
| Rate for Payer: Quartz Commercial |
$1,277.94
|
| Rate for Payer: The Alliance Commercial |
$1,121.00
|
| Rate for Payer: WEA Trust Commercial |
$1,233.10
|
| Rate for Payer: WPS Commercial |
$1,660.65
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
OP
|
$2,076.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
631503
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,136.96 |
| Rate for Payer: Aetna Commercial |
$1,868.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,785.36
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,349.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,038.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$996.48
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$1,909.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,161.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$1,847.64
|
| Rate for Payer: HFN Commercial |
$1,909.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$1,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,909.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.24
|
| Rate for Payer: Quartz Commercial |
$1,349.40
|
| Rate for Payer: Quartz Medicare Advantage |
$534.24
|
| Rate for Payer: The Alliance Commercial |
$2,136.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.24
|
| Rate for Payer: WEA Trust Commercial |
$1,141.80
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,537.69
|
|
|
NM Breast Tumor Localization
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675701
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Aetna Commercial |
$1,984.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,896.30
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.40
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,168.65
|
| 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 |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,028.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,233.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,962.45
|
| Rate for Payer: HFN Commercial |
$2,028.60
|
| 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 |
$1,764.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,028.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.45
|
| Rate for Payer: Quartz Commercial |
$1,433.25
|
| 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 |
$1,212.75
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,633.24
|
|
|
NM Breast Tumor Localization
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675701
|
| Min. Negotiated Rate |
$1,080.45 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Aetna Commercial |
$1,984.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,896.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,168.65
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,028.60
|
| Rate for Payer: Health EOS Commercial |
$1,962.45
|
| Rate for Payer: HFN Commercial |
$2,028.60
|
| Rate for Payer: Multiplan Commercial |
$1,764.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,028.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.45
|
| Rate for Payer: Quartz Commercial |
$1,323.00
|
| Rate for Payer: WEA Trust Commercial |
$1,212.75
|
| Rate for Payer: WPS Commercial |
$1,633.24
|
|
|
NM Breast Tumor Localization
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$871.10 |
| Max. Negotiated Rate |
$2,178.35 |
| Rate for Payer: Aetna Commercial |
$2,178.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,178.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,375.80
|
| Rate for Payer: Health EOS Commercial |
$2,086.63
|
| Rate for Payer: HFN Commercial |
$2,178.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.10
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.92
|
| Rate for Payer: Quartz Commercial |
$1,307.01
|
| Rate for Payer: The Alliance Commercial |
$1,146.50
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
NM Breast Tumor Localization
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| 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 |
$1,215.29
|
| 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 |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| 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 |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,490.45
|
| 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 |
$1,261.15
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
NM Breast Tumor Localization
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,123.57 |
| Max. Negotiated Rate |
$2,109.56 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,375.80
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
