|
NM Lymphoscintigraphy
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$729.52 |
| Max. Negotiated Rate |
$1,575.10 |
| Rate for Payer: Aetna Commercial |
$1,575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,425.88
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,575.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$829.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.80
|
| Rate for Payer: Health EOS Commercial |
$1,508.78
|
| Rate for Payer: HFN Commercial |
$1,575.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,209.63
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.10
|
| Rate for Payer: Quartz Beloit One Network |
$729.52
|
| Rate for Payer: Quartz Commercial |
$945.06
|
| Rate for Payer: The Alliance Commercial |
$829.00
|
| Rate for Payer: WEA Trust Commercial |
$911.90
|
| Rate for Payer: WPS Commercial |
$1,228.08
|
|
|
NM Lymphoscintigraphy
|
Professional
|
Both
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$948.64 |
| Max. Negotiated Rate |
$2,048.20 |
| Rate for Payer: Aetna Commercial |
$2,048.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,854.16
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,048.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,078.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,293.60
|
| Rate for Payer: Health EOS Commercial |
$1,961.96
|
| Rate for Payer: HFN Commercial |
$2,048.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,209.63
|
| Rate for Payer: Multiplan Commercial |
$1,724.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,048.20
|
| Rate for Payer: Quartz Beloit One Network |
$948.64
|
| Rate for Payer: Quartz Commercial |
$1,228.92
|
| Rate for Payer: The Alliance Commercial |
$1,078.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.80
|
| Rate for Payer: WPS Commercial |
$1,596.95
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,854.16
|
| 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 |
$1,142.68
|
| 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 |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$1,983.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,206.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$1,918.84
|
| Rate for Payer: HFN Commercial |
$1,983.52
|
| 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 |
$1,724.80
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,983.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,056.44
|
| Rate for Payer: Quartz Commercial |
$1,401.40
|
| 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: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.80
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,596.95
|
|
|
NM Lymphoscintigraphy
|
Facility
|
IP
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$1,983.52 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,854.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.68
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$1,983.52
|
| Rate for Payer: Health EOS Commercial |
$1,918.84
|
| Rate for Payer: HFN Commercial |
$1,983.52
|
| Rate for Payer: Multiplan Commercial |
$1,724.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,293.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,983.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,056.44
|
| Rate for Payer: Quartz Commercial |
$1,293.60
|
| Rate for Payer: WEA Trust Commercial |
$1,185.80
|
| Rate for Payer: WPS Commercial |
$1,596.95
|
|
|
NM Lymphoscintigraphy
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$812.42 |
| Max. Negotiated Rate |
$1,525.36 |
| Rate for Payer: Aetna Commercial |
$1,492.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,425.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.74
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,525.36
|
| Rate for Payer: Health EOS Commercial |
$1,475.62
|
| Rate for Payer: HFN Commercial |
$1,525.36
|
| Rate for Payer: Multiplan Commercial |
$1,326.40
|
| Rate for Payer: NAPHCARE Commercial |
$994.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,525.36
|
| Rate for Payer: Quartz Beloit One Network |
$812.42
|
| Rate for Payer: Quartz Commercial |
$994.80
|
| Rate for Payer: WEA Trust Commercial |
$911.90
|
| Rate for Payer: WPS Commercial |
$1,228.08
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,136.96 |
| Rate for Payer: Aetna Commercial |
$1,492.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,425.88
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,077.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$829.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$795.84
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.74
|
| 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 |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,525.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$927.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$1,475.62
|
| Rate for Payer: HFN Commercial |
$1,525.36
|
| 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 |
$1,326.40
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,525.36
|
| Rate for Payer: Quartz Beloit One Network |
$812.42
|
| Rate for Payer: Quartz Commercial |
$1,077.70
|
| 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 |
$911.90
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,228.08
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
IP
|
$2,108.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580816
|
| Min. Negotiated Rate |
$1,032.92 |
| Max. Negotiated Rate |
$1,939.36 |
| Rate for Payer: Aetna Commercial |
$1,897.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,117.24
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$1,939.36
|
| Rate for Payer: Health EOS Commercial |
$1,876.12
|
| Rate for Payer: HFN Commercial |
$1,939.36
|
| Rate for Payer: Multiplan Commercial |
$1,686.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,939.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.92
|
| Rate for Payer: Quartz Commercial |
$1,264.80
|
| Rate for Payer: WEA Trust Commercial |
$1,159.40
|
| Rate for Payer: WPS Commercial |
$1,561.40
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586911
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$2,082.40 |
| Rate for Payer: Aetna Commercial |
$2,082.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,082.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,096.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,315.20
|
| Rate for Payer: Health EOS Commercial |
$1,994.72
|
| Rate for Payer: HFN Commercial |
$2,082.40
|
| 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 |
$1,753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,082.40
|
| Rate for Payer: Quartz Beloit One Network |
$964.48
|
| Rate for Payer: Quartz Commercial |
$1,249.44
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: WEA Trust Commercial |
$1,205.60
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586911
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| 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 |
$1,161.76
|
| 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 |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,016.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$1,950.88
|
| Rate for Payer: HFN Commercial |
$2,016.64
|
| 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 |
$1,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,016.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.08
|
| Rate for Payer: Quartz Commercial |
$1,424.80
|
| 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 |
$1,205.60
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586911
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,074.08 |
| Max. Negotiated Rate |
$2,016.64 |
| Rate for Payer: Aetna Commercial |
$1,972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.76
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,016.64
|
| Rate for Payer: Health EOS Commercial |
$1,950.88
|
| Rate for Payer: HFN Commercial |
$2,016.64
|
| Rate for Payer: Multiplan Commercial |
$1,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,315.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,016.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.08
|
| Rate for Payer: Quartz Commercial |
$1,315.20
|
| Rate for Payer: WEA Trust Commercial |
$1,205.60
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Professional
|
Both
|
$2,108.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580816
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$2,002.60 |
| Rate for Payer: Aetna Commercial |
$2,002.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.88
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$2,002.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,054.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,264.80
|
| Rate for Payer: Health EOS Commercial |
$1,918.28
|
| Rate for Payer: HFN Commercial |
$2,002.60
|
| 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 |
$1,686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,002.60
|
| Rate for Payer: Quartz Beloit One Network |
$927.52
|
| Rate for Payer: Quartz Commercial |
$1,201.56
|
| Rate for Payer: The Alliance Commercial |
$1,054.00
|
| Rate for Payer: WEA Trust Commercial |
$1,159.40
|
| Rate for Payer: WPS Commercial |
$1,561.40
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
OP
|
$2,108.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580816
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$1,939.36 |
| Rate for Payer: Aetna Commercial |
$1,897.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.88
|
| Rate for Payer: Aetna Managed Medicare |
$245.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,370.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,054.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,011.84
|
| Rate for Payer: Anthem Medicare Advantage |
$245.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,117.24
|
| 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 |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$1,939.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$1,876.12
|
| Rate for Payer: HFN Commercial |
$1,939.36
|
| 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 |
$1,686.40
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,939.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.92
|
| Rate for Payer: Quartz Commercial |
$1,370.20
|
| 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: WEA Trust Commercial |
$1,159.40
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,561.40
|
|
|
NM Parathyroid Study
|
Professional
|
Both
|
$857.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
631473
|
| Min. Negotiated Rate |
$377.08 |
| Max. Negotiated Rate |
$1,006.47 |
| Rate for Payer: Aetna Commercial |
$814.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$814.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$428.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.20
|
| Rate for Payer: Health EOS Commercial |
$779.87
|
| Rate for Payer: HFN Commercial |
$814.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,006.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,006.47
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: Preferred Network Access Commercial |
$814.15
|
| Rate for Payer: Quartz Beloit One Network |
$377.08
|
| Rate for Payer: Quartz Commercial |
$488.49
|
| Rate for Payer: The Alliance Commercial |
$428.50
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
NM Parathyroid Study
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
631473
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$788.44 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$514.20
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
NM Parathyroid Study
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
631473
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,630.64 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$557.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$411.36
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| 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 |
$257.10
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$479.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| 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 |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$557.05
|
| 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 |
$471.35
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
NM Parathyroid Study
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
2586936
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,202.67 |
| Rate for Payer: Aetna Commercial |
$1,059.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.90
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,059.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$557.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$669.00
|
| Rate for Payer: Health EOS Commercial |
$1,014.65
|
| Rate for Payer: HFN Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,202.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,202.67
|
| Rate for Payer: Multiplan Commercial |
$892.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.25
|
| Rate for Payer: Quartz Beloit One Network |
$490.60
|
| Rate for Payer: Quartz Commercial |
$635.55
|
| Rate for Payer: The Alliance Commercial |
$557.50
|
| Rate for Payer: WEA Trust Commercial |
$613.25
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
NM Parathyroid Study
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
2586936
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.90
|
| 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 |
$590.95
|
| 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 |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,025.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$623.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$992.35
|
| Rate for Payer: HFN Commercial |
$1,025.80
|
| 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 |
$892.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,025.80
|
| Rate for Payer: Quartz Beloit One Network |
$546.35
|
| Rate for Payer: Quartz Commercial |
$724.75
|
| 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 |
$613.25
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
NM Parathyroid Study
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
2586936
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,025.80 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.95
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,025.80
|
| Rate for Payer: Health EOS Commercial |
$992.35
|
| Rate for Payer: HFN Commercial |
$1,025.80
|
| Rate for Payer: Multiplan Commercial |
$892.00
|
| Rate for Payer: NAPHCARE Commercial |
$669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,025.80
|
| Rate for Payer: Quartz Beloit One Network |
$546.35
|
| Rate for Payer: Quartz Commercial |
$669.00
|
| Rate for Payer: WEA Trust Commercial |
$613.25
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
2586943
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$984.41 |
| Max. Negotiated Rate |
$1,848.28 |
| Rate for Payer: Aetna Commercial |
$1,808.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,064.77
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cigna Commercial |
$1,848.28
|
| Rate for Payer: Health EOS Commercial |
$1,788.01
|
| Rate for Payer: HFN Commercial |
$1,848.28
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,205.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.28
|
| Rate for Payer: Quartz Beloit One Network |
$984.41
|
| Rate for Payer: Quartz Commercial |
$1,205.40
|
| Rate for Payer: WEA Trust Commercial |
$1,104.95
|
| Rate for Payer: WPS Commercial |
$1,488.07
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
2586943
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,808.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.74
|
| 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 |
$1,064.77
|
| 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 |
$602.70
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cigna Commercial |
$1,848.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,124.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,788.01
|
| Rate for Payer: HFN Commercial |
$1,848.28
|
| 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 |
$1,607.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.28
|
| Rate for Payer: Quartz Beloit One Network |
$984.41
|
| Rate for Payer: Quartz Commercial |
$1,305.85
|
| 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: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,104.95
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,488.07
|
|
|
NM Pulmonary Perfusion Imaging
|
Professional
|
Both
|
$1,862.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
631505
|
| Min. Negotiated Rate |
$806.46 |
| Max. Negotiated Rate |
$1,768.90 |
| Rate for Payer: Aetna Commercial |
$1,768.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.32
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,768.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$931.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.20
|
| Rate for Payer: Health EOS Commercial |
$1,694.42
|
| Rate for Payer: HFN Commercial |
$1,768.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$806.46
|
| Rate for Payer: Multiplan Commercial |
$1,489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.90
|
| Rate for Payer: Quartz Beloit One Network |
$819.28
|
| Rate for Payer: Quartz Commercial |
$1,061.34
|
| Rate for Payer: The Alliance Commercial |
$931.00
|
| Rate for Payer: WEA Trust Commercial |
$1,024.10
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
631505
|
| Min. Negotiated Rate |
$912.38 |
| Max. Negotiated Rate |
$1,713.04 |
| Rate for Payer: Aetna Commercial |
$1,675.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.86
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,713.04
|
| Rate for Payer: Health EOS Commercial |
$1,657.18
|
| Rate for Payer: HFN Commercial |
$1,713.04
|
| Rate for Payer: Multiplan Commercial |
$1,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.04
|
| Rate for Payer: Quartz Beloit One Network |
$912.38
|
| Rate for Payer: Quartz Commercial |
$1,117.20
|
| Rate for Payer: WEA Trust Commercial |
$1,024.10
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
NM Pulmonary Perfusion Imaging
|
Professional
|
Both
|
$2,009.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
2586943
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$806.46 |
| Max. Negotiated Rate |
$1,908.55 |
| Rate for Payer: Aetna Commercial |
$1,908.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.74
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cigna Commercial |
$1,908.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,004.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,205.40
|
| Rate for Payer: Health EOS Commercial |
$1,828.19
|
| Rate for Payer: HFN Commercial |
$1,908.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$806.46
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,908.55
|
| Rate for Payer: Quartz Beloit One Network |
$883.96
|
| Rate for Payer: Quartz Commercial |
$1,145.13
|
| Rate for Payer: The Alliance Commercial |
$1,004.50
|
| Rate for Payer: WEA Trust Commercial |
$1,104.95
|
| Rate for Payer: WPS Commercial |
$1,488.07
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
631505
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,713.04 |
| Rate for Payer: Aetna Commercial |
$1,675.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.32
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.76
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.86
|
| 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 |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,713.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,657.18
|
| Rate for Payer: HFN Commercial |
$1,713.04
|
| 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 |
$1,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.04
|
| Rate for Payer: Quartz Beloit One Network |
$912.38
|
| Rate for Payer: Quartz Commercial |
$1,210.30
|
| 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 |
$1,024.10
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,379.18
|
|
|
NM Pulmonary Perfusion w/ Ventilation
|
Facility
|
IP
|
$3,212.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
2586945
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,573.88 |
| Max. Negotiated Rate |
$2,955.04 |
| Rate for Payer: Aetna Commercial |
$2,890.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,702.36
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$2,955.04
|
| Rate for Payer: Health EOS Commercial |
$2,858.68
|
| Rate for Payer: HFN Commercial |
$2,955.04
|
| Rate for Payer: Multiplan Commercial |
$2,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,927.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,573.88
|
| Rate for Payer: Quartz Commercial |
$1,927.20
|
| Rate for Payer: WEA Trust Commercial |
$1,766.60
|
| Rate for Payer: WPS Commercial |
$2,379.13
|
|
