|
NM Breast Tumor Localization
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675701
|
| Min. Negotiated Rate |
$871.10 |
| Max. Negotiated Rate |
$2,094.75 |
| Rate for Payer: Aetna Commercial |
$2,094.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,896.30
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,094.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,102.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,323.00
|
| Rate for Payer: Health EOS Commercial |
$2,006.55
|
| Rate for Payer: HFN Commercial |
$2,094.75
|
| 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 |
$1,764.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,094.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.20
|
| Rate for Payer: Quartz Commercial |
$1,256.85
|
| Rate for Payer: The Alliance Commercial |
$1,102.50
|
| Rate for Payer: WEA Trust Commercial |
$1,212.75
|
| Rate for Payer: WPS Commercial |
$1,633.24
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
629686
|
| Min. Negotiated Rate |
$947.52 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,551.00
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: HFN Commercial |
$2,455.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$947.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$947.52
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: The Alliance Commercial |
$1,292.50
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
629686
|
| Min. Negotiated Rate |
$1,240.80 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| 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 |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| 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 |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| 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 |
$1,421.75
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Professional
|
Both
|
$2,688.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
2586853
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$947.52 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Aetna Commercial |
$2,553.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.68
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$2,553.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,344.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,612.80
|
| Rate for Payer: Health EOS Commercial |
$2,446.08
|
| Rate for Payer: HFN Commercial |
$2,553.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$947.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$947.52
|
| Rate for Payer: Multiplan Commercial |
$2,150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.72
|
| Rate for Payer: Quartz Commercial |
$1,532.16
|
| Rate for Payer: The Alliance Commercial |
$1,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,478.40
|
| Rate for Payer: WPS Commercial |
$1,991.00
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
2586853
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,317.12 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$2,419.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.68
|
| 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 |
$1,424.64
|
| 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 |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$2,472.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,504.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$2,392.32
|
| Rate for Payer: HFN Commercial |
$2,472.96
|
| 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 |
$2,150.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.12
|
| Rate for Payer: Quartz Commercial |
$1,747.20
|
| 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 |
$1,478.40
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$1,991.00
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
2586853
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,317.12 |
| Max. Negotiated Rate |
$2,472.96 |
| Rate for Payer: Aetna Commercial |
$2,419.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.64
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$2,472.96
|
| Rate for Payer: Health EOS Commercial |
$2,392.32
|
| Rate for Payer: HFN Commercial |
$2,472.96
|
| Rate for Payer: Multiplan Commercial |
$2,150.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.12
|
| Rate for Payer: Quartz Commercial |
$1,612.80
|
| Rate for Payer: WEA Trust Commercial |
$1,478.40
|
| Rate for Payer: WPS Commercial |
$1,991.00
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
629686
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
2586857
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,198.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.98
|
| 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 |
$1,294.79
|
| 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 |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cigna Commercial |
$2,247.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,367.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,174.27
|
| Rate for Payer: HFN Commercial |
$2,247.56
|
| 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 |
$1,954.40
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,247.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.07
|
| Rate for Payer: Quartz Commercial |
$1,587.95
|
| 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 |
$1,343.65
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,809.53
|
|
|
NM Cisternography/Cerebrospinal
|
Professional
|
Both
|
$2,349.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
629748
|
| Min. Negotiated Rate |
$1,033.56 |
| Max. Negotiated Rate |
$2,231.55 |
| Rate for Payer: Aetna Commercial |
$2,231.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,020.14
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,231.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,174.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,409.40
|
| Rate for Payer: Health EOS Commercial |
$2,137.59
|
| Rate for Payer: HFN Commercial |
$2,231.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,149.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,149.86
|
| Rate for Payer: Multiplan Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.56
|
| Rate for Payer: Quartz Commercial |
$1,338.93
|
| Rate for Payer: The Alliance Commercial |
$1,174.50
|
| Rate for Payer: WEA Trust Commercial |
$1,291.95
|
| Rate for Payer: WPS Commercial |
$1,739.90
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
2586857
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,197.07 |
| Max. Negotiated Rate |
$2,247.56 |
| Rate for Payer: Aetna Commercial |
$2,198.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,294.79
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cigna Commercial |
$2,247.56
|
| Rate for Payer: Health EOS Commercial |
$2,174.27
|
| Rate for Payer: HFN Commercial |
$2,247.56
|
| Rate for Payer: Multiplan Commercial |
$1,954.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,465.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,247.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.07
|
| Rate for Payer: Quartz Commercial |
$1,465.80
|
| Rate for Payer: WEA Trust Commercial |
$1,343.65
|
| Rate for Payer: WPS Commercial |
$1,809.53
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
OP
|
$2,349.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
629748
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,161.08 |
| Rate for Payer: Aetna Commercial |
$2,114.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,020.14
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,526.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,127.52
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.97
|
| 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 |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,161.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,314.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,090.61
|
| Rate for Payer: HFN Commercial |
$2,161.08
|
| 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 |
$1,879.20
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,161.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,151.01
|
| Rate for Payer: Quartz Commercial |
$1,526.85
|
| 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 |
$1,291.95
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,739.90
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
IP
|
$2,349.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
629748
|
| Min. Negotiated Rate |
$1,151.01 |
| Max. Negotiated Rate |
$2,161.08 |
| Rate for Payer: Aetna Commercial |
$2,114.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,020.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.97
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,161.08
|
| Rate for Payer: Health EOS Commercial |
$2,090.61
|
| Rate for Payer: HFN Commercial |
$2,161.08
|
| Rate for Payer: Multiplan Commercial |
$1,879.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,409.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,161.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,151.01
|
| Rate for Payer: Quartz Commercial |
$1,409.40
|
| Rate for Payer: WEA Trust Commercial |
$1,291.95
|
| Rate for Payer: WPS Commercial |
$1,739.90
|
|
|
NM Cisternography/Cerebrospinal
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
2586857
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,074.92 |
| Max. Negotiated Rate |
$2,320.85 |
| Rate for Payer: Aetna Commercial |
$2,320.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.98
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cigna Commercial |
$2,320.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,221.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,465.80
|
| Rate for Payer: Health EOS Commercial |
$2,223.13
|
| Rate for Payer: HFN Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,149.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,149.86
|
| Rate for Payer: Multiplan Commercial |
$1,954.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,320.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.92
|
| Rate for Payer: Quartz Commercial |
$1,392.51
|
| Rate for Payer: The Alliance Commercial |
$1,221.50
|
| Rate for Payer: WEA Trust Commercial |
$1,343.65
|
| Rate for Payer: WPS Commercial |
$1,809.53
|
|
|
N. meningitidis Group A/Y Antigen
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
N. meningitidis Group A/Y Antigen
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.16
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.54
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Dean Health Medicaid |
$11.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.54
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.54
|
| Rate for Payer: Managed Health Services Medicaid |
$12.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.31
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.92
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$11.54
|
| Rate for Payer: The Alliance Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicaid |
$11.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
| Rate for Payer: WMAP Medicaid |
$11.92
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
N. meningitidis Group A/Y Antigen
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$83.72
|
| Rate for Payer: HFN Commercial |
$87.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.74
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Preferred Network Access Commercial |
$87.40
|
| Rate for Payer: Quartz Beloit One Network |
$40.48
|
| Rate for Payer: Quartz Commercial |
$52.44
|
| Rate for Payer: The Alliance Commercial |
$46.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
N. meningitidis Group B/E, Coli K1 Antigen
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
N. meningitidis Group B/E, Coli K1 Antigen
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$83.72
|
| Rate for Payer: HFN Commercial |
$87.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.74
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Preferred Network Access Commercial |
$87.40
|
| Rate for Payer: Quartz Beloit One Network |
$40.48
|
| Rate for Payer: Quartz Commercial |
$52.44
|
| Rate for Payer: The Alliance Commercial |
$46.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
N. meningitidis Group B/E, Coli K1 Antigen
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.16
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.54
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Dean Health Medicaid |
$11.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.54
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.54
|
| Rate for Payer: Managed Health Services Medicaid |
$12.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.31
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.92
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$11.54
|
| Rate for Payer: The Alliance Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicaid |
$11.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
| Rate for Payer: WMAP Medicaid |
$11.92
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
N-Methylhistamine, 24 Hr Urine
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5098624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
N-Methylhistamine, 24 Hr Urine
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5098624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
N-Methylhistamine, 24 Hr Urine
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5098624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
NM Gastric Emptying Study
|
Facility
|
OP
|
$2,878.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
631161
|
| 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 |
$1,870.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,439.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,381.44
|
| 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: 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: WEA Trust Commercial |
$1,582.90
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,131.73
|
|
|
NM Gastric Emptying Study
|
Facility
|
IP
|
$2,878.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
631161
|
| 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 Gastric Emptying Study
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
631161
|
| Min. Negotiated Rate |
$1,132.07 |
| 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 |
$1,132.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,132.07
|
| 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
|
|
