|
NM Gastric Emptying Study
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2586863
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,861.20 |
| Rate for Payer: Aetna Commercial |
$2,799.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.60
|
| 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 |
$1,648.30
|
| 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 |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$2,861.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,767.90
|
| Rate for Payer: HFN Commercial |
$2,861.20
|
| 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 |
$2,488.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,861.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.90
|
| Rate for Payer: Quartz Commercial |
$2,021.50
|
| 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 |
$1,710.50
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,303.58
|
|
|
NM Gastric Emptying Study
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2586863
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,523.90 |
| Max. Negotiated Rate |
$2,861.20 |
| Rate for Payer: Aetna Commercial |
$2,799.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.30
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$2,861.20
|
| Rate for Payer: Health EOS Commercial |
$2,767.90
|
| Rate for Payer: HFN Commercial |
$2,861.20
|
| Rate for Payer: Multiplan Commercial |
$2,488.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,866.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,861.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.90
|
| Rate for Payer: Quartz Commercial |
$1,866.00
|
| Rate for Payer: WEA Trust Commercial |
$1,710.50
|
| Rate for Payer: WPS Commercial |
$2,303.58
|
|
|
NM Gastric Emptying Study
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2586863
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,132.07 |
| Max. Negotiated Rate |
$2,954.50 |
| Rate for Payer: Aetna Commercial |
$2,954.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,674.60
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$2,954.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,555.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,866.00
|
| Rate for Payer: Health EOS Commercial |
$2,830.10
|
| Rate for Payer: HFN Commercial |
$2,954.50
|
| 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 |
$2,488.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,954.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.40
|
| Rate for Payer: Quartz Commercial |
$1,772.70
|
| Rate for Payer: The Alliance Commercial |
$1,555.00
|
| Rate for Payer: WEA Trust Commercial |
$1,710.50
|
| Rate for Payer: WPS Commercial |
$2,303.58
|
|
|
NM Gastric Mucosa Imaging
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 78261
|
| Hospital Charge Code |
2586865
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,893.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,809.44
|
| 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 |
$1,115.12
|
| 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 |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$1,935.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,872.56
|
| Rate for Payer: HFN Commercial |
$1,935.68
|
| 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 |
$1,683.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,935.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.96
|
| Rate for Payer: Quartz Commercial |
$1,367.60
|
| 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: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.20
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,558.43
|
|
|
NM Gastric Mucosa Imaging
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 78261
|
| Hospital Charge Code |
2586865
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,030.96 |
| Max. Negotiated Rate |
$1,935.68 |
| Rate for Payer: Aetna Commercial |
$1,893.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,809.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.12
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$1,935.68
|
| Rate for Payer: Health EOS Commercial |
$1,872.56
|
| Rate for Payer: HFN Commercial |
$1,935.68
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,935.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.96
|
| Rate for Payer: Quartz Commercial |
$1,262.40
|
| Rate for Payer: WEA Trust Commercial |
$1,157.20
|
| Rate for Payer: WPS Commercial |
$1,558.43
|
|
|
NM Gastric Mucosa Imaging
|
Professional
|
Both
|
$2,104.00
|
|
|
Service Code
|
CPT 78261
|
| Hospital Charge Code |
2586865
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$700.60 |
| Max. Negotiated Rate |
$1,998.80 |
| Rate for Payer: Aetna Commercial |
$1,998.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,809.44
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$1,998.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,052.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,262.40
|
| Rate for Payer: Health EOS Commercial |
$1,914.64
|
| Rate for Payer: HFN Commercial |
$1,998.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$700.60
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,998.80
|
| Rate for Payer: Quartz Beloit One Network |
$925.76
|
| Rate for Payer: Quartz Commercial |
$1,199.28
|
| Rate for Payer: The Alliance Commercial |
$1,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.20
|
| Rate for Payer: WPS Commercial |
$1,558.43
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
IP
|
$2,876.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2586867
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,409.24 |
| Max. Negotiated Rate |
$2,645.92 |
| Rate for Payer: Aetna Commercial |
$2,588.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,473.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.28
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$2,645.92
|
| Rate for Payer: Health EOS Commercial |
$2,559.64
|
| Rate for Payer: HFN Commercial |
$2,645.92
|
| Rate for Payer: Multiplan Commercial |
$2,300.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,725.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,645.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.24
|
| Rate for Payer: Quartz Commercial |
$1,725.60
|
| Rate for Payer: WEA Trust Commercial |
$1,581.80
|
| Rate for Payer: WPS Commercial |
$2,130.25
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Professional
|
Both
|
$2,664.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
631165
|
| Min. Negotiated Rate |
$1,172.16 |
| Max. Negotiated Rate |
$2,530.80 |
| Rate for Payer: Aetna Commercial |
$2,530.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,291.04
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$2,530.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,332.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,598.40
|
| Rate for Payer: Health EOS Commercial |
$2,424.24
|
| Rate for Payer: HFN Commercial |
$2,530.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,188.06
|
| Rate for Payer: Multiplan Commercial |
$2,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.16
|
| Rate for Payer: Quartz Commercial |
$1,518.48
|
| Rate for Payer: The Alliance Commercial |
$1,332.00
|
| Rate for Payer: WEA Trust Commercial |
$1,465.20
|
| Rate for Payer: WPS Commercial |
$1,973.22
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
IP
|
$2,664.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
631165
|
| Min. Negotiated Rate |
$1,305.36 |
| Max. Negotiated Rate |
$2,450.88 |
| Rate for Payer: Aetna Commercial |
$2,397.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,291.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,411.92
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$2,450.88
|
| Rate for Payer: Health EOS Commercial |
$2,370.96
|
| Rate for Payer: HFN Commercial |
$2,450.88
|
| Rate for Payer: Multiplan Commercial |
$2,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,598.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,450.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,305.36
|
| Rate for Payer: Quartz Commercial |
$1,598.40
|
| Rate for Payer: WEA Trust Commercial |
$1,465.20
|
| Rate for Payer: WPS Commercial |
$1,973.22
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
OP
|
$2,664.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
631165
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,450.88 |
| Rate for Payer: Aetna Commercial |
$2,397.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,291.04
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,731.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,278.72
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,411.92
|
| 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 |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$2,450.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,490.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,370.96
|
| Rate for Payer: HFN Commercial |
$2,450.88
|
| 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 |
$2,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,450.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,305.36
|
| Rate for Payer: Quartz Commercial |
$1,731.60
|
| 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 |
$1,465.20
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,973.22
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
OP
|
$2,876.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2586867
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,645.92 |
| Rate for Payer: Aetna Commercial |
$2,588.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,473.36
|
| 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 |
$1,524.28
|
| 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 |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$2,645.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,609.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,559.64
|
| Rate for Payer: HFN Commercial |
$2,645.92
|
| 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 |
$2,300.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,645.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.24
|
| Rate for Payer: Quartz Commercial |
$1,869.40
|
| 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 |
$1,581.80
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,130.25
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Professional
|
Both
|
$2,876.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2586867
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,188.06 |
| Max. Negotiated Rate |
$2,732.20 |
| Rate for Payer: Aetna Commercial |
$2,732.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,473.36
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$2,732.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,438.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,725.60
|
| Rate for Payer: Health EOS Commercial |
$2,617.16
|
| Rate for Payer: HFN Commercial |
$2,732.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,188.06
|
| Rate for Payer: Multiplan Commercial |
$2,300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,732.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.44
|
| Rate for Payer: Quartz Commercial |
$1,639.32
|
| Rate for Payer: The Alliance Commercial |
$1,438.00
|
| Rate for Payer: WEA Trust Commercial |
$1,581.80
|
| Rate for Payer: WPS Commercial |
$2,130.25
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2586873
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,200.50 |
| Max. Negotiated Rate |
$2,254.00 |
| Rate for Payer: Aetna Commercial |
$2,205.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.50
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,254.00
|
| Rate for Payer: Health EOS Commercial |
$2,180.50
|
| Rate for Payer: HFN Commercial |
$2,254.00
|
| Rate for Payer: Multiplan Commercial |
$1,960.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.50
|
| Rate for Payer: Quartz Commercial |
$1,470.00
|
| Rate for Payer: WEA Trust Commercial |
$1,347.50
|
| Rate for Payer: WPS Commercial |
$1,814.72
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2586873
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,205.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.00
|
| 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 |
$1,298.50
|
| 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 |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,254.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,180.50
|
| Rate for Payer: HFN Commercial |
$2,254.00
|
| 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 |
$1,960.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.50
|
| Rate for Payer: Quartz Commercial |
$1,592.50
|
| 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 |
$1,347.50
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,814.72
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
IP
|
$2,269.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
631211
|
| Min. Negotiated Rate |
$1,111.81 |
| Max. Negotiated Rate |
$2,087.48 |
| Rate for Payer: Aetna Commercial |
$2,042.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,951.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,202.57
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,087.48
|
| Rate for Payer: Health EOS Commercial |
$2,019.41
|
| Rate for Payer: HFN Commercial |
$2,087.48
|
| Rate for Payer: Multiplan Commercial |
$1,815.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,361.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,087.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,111.81
|
| Rate for Payer: Quartz Commercial |
$1,361.40
|
| Rate for Payer: WEA Trust Commercial |
$1,247.95
|
| Rate for Payer: WPS Commercial |
$1,680.65
|
|
|
NM Hepatobiliary Duct System Imaging
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2586873
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$2,327.50 |
| Rate for Payer: Aetna Commercial |
$2,327.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,327.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,225.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,470.00
|
| Rate for Payer: Health EOS Commercial |
$2,229.50
|
| Rate for Payer: HFN Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,115.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,115.48
|
| Rate for Payer: Multiplan Commercial |
$1,960.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,327.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.00
|
| Rate for Payer: Quartz Commercial |
$1,396.50
|
| Rate for Payer: The Alliance Commercial |
$1,225.00
|
| Rate for Payer: WEA Trust Commercial |
$1,347.50
|
| Rate for Payer: WPS Commercial |
$1,814.72
|
|
|
NM Hepatobiliary Duct System Imaging
|
Professional
|
Both
|
$2,269.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
631211
|
| Min. Negotiated Rate |
$998.36 |
| Max. Negotiated Rate |
$2,155.55 |
| Rate for Payer: Aetna Commercial |
$2,155.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,951.34
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,155.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,134.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,361.40
|
| Rate for Payer: Health EOS Commercial |
$2,064.79
|
| Rate for Payer: HFN Commercial |
$2,155.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,115.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,115.48
|
| Rate for Payer: Multiplan Commercial |
$1,815.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,155.55
|
| Rate for Payer: Quartz Beloit One Network |
$998.36
|
| Rate for Payer: Quartz Commercial |
$1,293.33
|
| Rate for Payer: The Alliance Commercial |
$1,134.50
|
| Rate for Payer: WEA Trust Commercial |
$1,247.95
|
| Rate for Payer: WPS Commercial |
$1,680.65
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
OP
|
$2,269.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
631211
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,087.48 |
| Rate for Payer: Aetna Commercial |
$2,042.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,951.34
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,474.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,089.12
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,202.57
|
| 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 |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,087.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,269.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,019.41
|
| Rate for Payer: HFN Commercial |
$2,087.48
|
| 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 |
$1,815.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,087.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,111.81
|
| Rate for Payer: Quartz Commercial |
$1,474.85
|
| 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 |
$1,247.95
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,680.65
|
|
|
NM Hepatobiliary System Imaging w Pharm
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2586875
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,124.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,029.60
|
| 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 |
$1,250.80
|
| 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 |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$2,171.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,320.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,100.40
|
| Rate for Payer: HFN Commercial |
$2,171.20
|
| 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 |
$1,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.40
|
| Rate for Payer: Quartz Commercial |
$1,534.00
|
| 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 |
$1,298.00
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,748.05
|
|
|
NM Hepatobiliary System Imaging w Pharm
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2586875
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,156.40 |
| Max. Negotiated Rate |
$2,171.20 |
| Rate for Payer: Aetna Commercial |
$2,124.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,029.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,250.80
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$2,171.20
|
| Rate for Payer: Health EOS Commercial |
$2,100.40
|
| Rate for Payer: HFN Commercial |
$2,171.20
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,416.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.40
|
| Rate for Payer: Quartz Commercial |
$1,416.00
|
| Rate for Payer: WEA Trust Commercial |
$1,298.00
|
| Rate for Payer: WPS Commercial |
$1,748.05
|
|
|
NM Hepatobiliary System Imaging w Pharm
|
Professional
|
Both
|
$2,360.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2586875
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,038.40 |
| Max. Negotiated Rate |
$2,242.00 |
| Rate for Payer: Aetna Commercial |
$2,242.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,029.60
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$2,242.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,180.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,416.00
|
| Rate for Payer: Health EOS Commercial |
$2,147.60
|
| Rate for Payer: HFN Commercial |
$2,242.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,503.00
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,038.40
|
| Rate for Payer: Quartz Commercial |
$1,345.20
|
| Rate for Payer: The Alliance Commercial |
$1,180.00
|
| Rate for Payer: WEA Trust Commercial |
$1,298.00
|
| Rate for Payer: WPS Commercial |
$1,748.05
|
|
|
NM Hyperthyroid Oral Therapy
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586878
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
NM Hyperthyroid Oral Therapy
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586878
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$245.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$922.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$737.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$700.82
|
| Rate for Payer: Anthem Medicare Advantage |
$245.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$245.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$245.90
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$914.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$245.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$245.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$245.90
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$245.90
|
| Rate for Payer: The Alliance Commercial |
$983.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.90
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
NM Hyperthyroid Oral Therapy
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586878
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$2,276.20 |
| Rate for Payer: Aetna Commercial |
$2,276.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,276.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,198.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,437.60
|
| Rate for Payer: Health EOS Commercial |
$2,180.36
|
| Rate for Payer: HFN Commercial |
$2,276.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$468.29
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,276.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.24
|
| Rate for Payer: Quartz Commercial |
$1,365.72
|
| Rate for Payer: The Alliance Commercial |
$1,198.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
NMIC 306
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
