|
NM Pulmonary Perfusion w/ Ventilation
|
Facility
|
IP
|
$3,333.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
631515
|
| Min. Negotiated Rate |
$1,633.17 |
| Max. Negotiated Rate |
$3,066.36 |
| Rate for Payer: Aetna Commercial |
$2,999.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,866.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,766.49
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cigna Commercial |
$3,066.36
|
| Rate for Payer: Health EOS Commercial |
$2,966.37
|
| Rate for Payer: HFN Commercial |
$3,066.36
|
| Rate for Payer: Multiplan Commercial |
$2,666.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,999.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,066.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,633.17
|
| Rate for Payer: Quartz Commercial |
$1,999.80
|
| Rate for Payer: WEA Trust Commercial |
$1,833.15
|
| Rate for Payer: WPS Commercial |
$2,468.75
|
|
|
NM Pulmonary Perfusion w/ Ventilation
|
Professional
|
Both
|
$3,212.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
2586945
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,136.41 |
| Max. Negotiated Rate |
$3,051.40 |
| Rate for Payer: Aetna Commercial |
$3,051.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.32
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$3,051.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,606.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,927.20
|
| Rate for Payer: Health EOS Commercial |
$2,922.92
|
| Rate for Payer: HFN Commercial |
$3,051.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,136.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,136.41
|
| Rate for Payer: Multiplan Commercial |
$2,569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,051.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,413.28
|
| Rate for Payer: Quartz Commercial |
$1,830.84
|
| Rate for Payer: The Alliance Commercial |
$1,606.00
|
| Rate for Payer: WEA Trust Commercial |
$1,766.60
|
| Rate for Payer: WPS Commercial |
$2,379.13
|
|
|
NM Pulmonary Perfusion w/ Ventilation
|
Facility
|
OP
|
$3,212.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
2586945
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| 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: 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 |
$1,702.36
|
| 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 |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$2,955.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,797.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,858.68
|
| Rate for Payer: HFN Commercial |
$2,955.04
|
| 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 |
$2,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| 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 |
$2,087.80
|
| 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 |
$1,766.60
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,379.13
|
|
|
NM Pulmonary Perfusion w/ Ventilation
|
Professional
|
Both
|
$3,333.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
631515
|
| Min. Negotiated Rate |
$1,136.41 |
| Max. Negotiated Rate |
$3,166.35 |
| Rate for Payer: Aetna Commercial |
$3,166.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,866.38
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cigna Commercial |
$3,166.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,666.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,999.80
|
| Rate for Payer: Health EOS Commercial |
$3,033.03
|
| Rate for Payer: HFN Commercial |
$3,166.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,136.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,136.41
|
| Rate for Payer: Multiplan Commercial |
$2,666.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,166.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.52
|
| Rate for Payer: Quartz Commercial |
$1,899.81
|
| Rate for Payer: The Alliance Commercial |
$1,666.50
|
| Rate for Payer: WEA Trust Commercial |
$1,833.15
|
| Rate for Payer: WPS Commercial |
$2,468.75
|
|
|
NM Pulmonary Perfusion w/ Ventilation
|
Facility
|
OP
|
$3,333.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
631515
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$3,066.36 |
| Rate for Payer: Aetna Commercial |
$2,999.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,866.38
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,166.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,666.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,599.84
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,766.49
|
| 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 |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cigna Commercial |
$3,066.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,865.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,966.37
|
| Rate for Payer: HFN Commercial |
$3,066.36
|
| 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 |
$2,666.40
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,066.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,633.17
|
| Rate for Payer: Quartz Commercial |
$2,166.45
|
| 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 |
$1,833.15
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,468.75
|
|
|
NM Pulmonary Ventilation Gaseous Single
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
2586949
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$691.88 |
| Max. Negotiated Rate |
$1,299.04 |
| Rate for Payer: Aetna Commercial |
$1,270.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.36
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,299.04
|
| Rate for Payer: Health EOS Commercial |
$1,256.68
|
| Rate for Payer: HFN Commercial |
$1,299.04
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$847.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.04
|
| Rate for Payer: Quartz Beloit One Network |
$691.88
|
| Rate for Payer: Quartz Commercial |
$847.20
|
| Rate for Payer: WEA Trust Commercial |
$776.60
|
| Rate for Payer: WPS Commercial |
$1,045.87
|
|
|
NM Pulmonary Ventilation Gaseous Single
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
2586949
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$621.28 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Aetna Commercial |
$1,341.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.32
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,341.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$706.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.20
|
| Rate for Payer: Health EOS Commercial |
$1,284.92
|
| Rate for Payer: HFN Commercial |
$1,341.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$636.88
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,341.40
|
| Rate for Payer: Quartz Beloit One Network |
$621.28
|
| Rate for Payer: Quartz Commercial |
$804.84
|
| Rate for Payer: The Alliance Commercial |
$706.00
|
| Rate for Payer: WEA Trust Commercial |
$776.60
|
| Rate for Payer: WPS Commercial |
$1,045.87
|
|
|
NM Pulmonary Ventilation Gaseous Single
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
2586949
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,270.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.32
|
| 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 |
$748.36
|
| 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 |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,299.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$790.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,256.68
|
| Rate for Payer: HFN Commercial |
$1,299.04
|
| 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 |
$1,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.04
|
| Rate for Payer: Quartz Beloit One Network |
$691.88
|
| Rate for Payer: Quartz Commercial |
$917.80
|
| 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 |
$776.60
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,045.87
|
|
|
NM Quantitative Pulmonary Perfusion
|
Facility
|
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
2942805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,485.19 |
| Max. Negotiated Rate |
$2,788.52 |
| Rate for Payer: Aetna Commercial |
$2,727.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,606.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,606.43
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,788.52
|
| Rate for Payer: Health EOS Commercial |
$2,697.59
|
| Rate for Payer: HFN Commercial |
$2,788.52
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,818.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,788.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.19
|
| Rate for Payer: Quartz Commercial |
$1,818.60
|
| Rate for Payer: WEA Trust Commercial |
$1,667.05
|
| Rate for Payer: WPS Commercial |
$2,245.06
|
|
|
NM Quantitative Pulmonary Perfusion
|
Facility
|
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
2942805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,788.52 |
| Rate for Payer: Aetna Commercial |
$2,727.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,606.66
|
| 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 |
$1,606.43
|
| 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 |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,788.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,696.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,697.59
|
| Rate for Payer: HFN Commercial |
$2,788.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,788.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.19
|
| Rate for Payer: Quartz Commercial |
$1,970.15
|
| 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 |
$1,667.05
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,245.06
|
|
|
NM Quantitative Pulmonary Perfusion
|
Professional
|
Both
|
$3,031.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
2942805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$689.37 |
| Max. Negotiated Rate |
$2,879.45 |
| Rate for Payer: Aetna Commercial |
$2,879.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,606.66
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,879.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,515.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,818.60
|
| Rate for Payer: Health EOS Commercial |
$2,758.21
|
| Rate for Payer: HFN Commercial |
$2,879.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$689.37
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,879.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.64
|
| Rate for Payer: Quartz Commercial |
$1,727.67
|
| Rate for Payer: The Alliance Commercial |
$1,515.50
|
| Rate for Payer: WEA Trust Commercial |
$1,667.05
|
| Rate for Payer: WPS Commercial |
$2,245.06
|
|
|
NM Quantitative Pulmonary Perf/Vent
|
Professional
|
Both
|
$3,152.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
2942802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,037.01 |
| Max. Negotiated Rate |
$2,994.40 |
| Rate for Payer: Aetna Commercial |
$2,994.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.72
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$2,994.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,576.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,891.20
|
| Rate for Payer: Health EOS Commercial |
$2,868.32
|
| Rate for Payer: HFN Commercial |
$2,994.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,037.01
|
| Rate for Payer: Multiplan Commercial |
$2,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,994.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.88
|
| Rate for Payer: Quartz Commercial |
$1,796.64
|
| Rate for Payer: The Alliance Commercial |
$1,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,733.60
|
| Rate for Payer: WPS Commercial |
$2,334.69
|
|
|
NM Quantitative Pulmonary Perf/Vent
|
Facility
|
OP
|
$3,152.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
2942802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,899.84 |
| Rate for Payer: Aetna Commercial |
$2,836.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.72
|
| 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 |
$1,670.56
|
| 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 |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$2,899.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,763.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,805.28
|
| Rate for Payer: HFN Commercial |
$2,899.84
|
| 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 |
$2,521.60
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,899.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.48
|
| Rate for Payer: Quartz Commercial |
$2,048.80
|
| 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 |
$1,733.60
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,334.69
|
|
|
NM Quantitative Pulmonary Perf/Vent
|
Facility
|
IP
|
$3,152.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
2942802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,544.48 |
| Max. Negotiated Rate |
$2,899.84 |
| Rate for Payer: Aetna Commercial |
$2,836.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.56
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$2,899.84
|
| Rate for Payer: Health EOS Commercial |
$2,805.28
|
| Rate for Payer: HFN Commercial |
$2,899.84
|
| Rate for Payer: Multiplan Commercial |
$2,521.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,891.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,899.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.48
|
| Rate for Payer: Quartz Commercial |
$1,891.20
|
| Rate for Payer: WEA Trust Commercial |
$1,733.60
|
| Rate for Payer: WPS Commercial |
$2,334.69
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
IP
|
$2,198.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2586951
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,077.02 |
| Max. Negotiated Rate |
$2,022.16 |
| Rate for Payer: Aetna Commercial |
$1,978.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.94
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,022.16
|
| Rate for Payer: Health EOS Commercial |
$1,956.22
|
| Rate for Payer: HFN Commercial |
$2,022.16
|
| Rate for Payer: Multiplan Commercial |
$1,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,318.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.02
|
| Rate for Payer: Quartz Commercial |
$1,318.80
|
| Rate for Payer: WEA Trust Commercial |
$1,208.90
|
| Rate for Payer: WPS Commercial |
$1,628.06
|
|
|
NM Radionuclide IV Therapy
|
Professional
|
Both
|
$2,198.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2586951
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$2,088.10 |
| Rate for Payer: Aetna Commercial |
$2,088.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.28
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,088.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,099.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,318.80
|
| Rate for Payer: Health EOS Commercial |
$2,000.18
|
| Rate for Payer: HFN Commercial |
$2,088.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.88
|
| Rate for Payer: Multiplan Commercial |
$1,758.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.10
|
| Rate for Payer: Quartz Beloit One Network |
$967.12
|
| Rate for Payer: Quartz Commercial |
$1,252.86
|
| Rate for Payer: The Alliance Commercial |
$1,099.00
|
| Rate for Payer: WEA Trust Commercial |
$1,208.90
|
| Rate for Payer: WPS Commercial |
$1,628.06
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
OP
|
$2,113.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2580818
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$1,943.96 |
| Rate for Payer: Aetna Commercial |
$1,901.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.18
|
| Rate for Payer: Aetna Managed Medicare |
$245.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,373.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,014.24
|
| Rate for Payer: Anthem Medicare Advantage |
$245.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.89
|
| 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 |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$1,943.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$1,880.57
|
| Rate for Payer: HFN Commercial |
$1,943.96
|
| 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 |
$1,690.40
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.37
|
| Rate for Payer: Quartz Commercial |
$1,373.45
|
| 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 |
$1,162.15
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,565.10
|
|
|
NM Radionuclide IV Therapy
|
Professional
|
Both
|
$2,113.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2580818
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$2,007.35 |
| Rate for Payer: Aetna Commercial |
$2,007.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.18
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,007.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,056.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,267.80
|
| Rate for Payer: Health EOS Commercial |
$1,922.83
|
| Rate for Payer: HFN Commercial |
$2,007.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.88
|
| Rate for Payer: Multiplan Commercial |
$1,690.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.35
|
| Rate for Payer: Quartz Beloit One Network |
$929.72
|
| Rate for Payer: Quartz Commercial |
$1,204.41
|
| Rate for Payer: The Alliance Commercial |
$1,056.50
|
| Rate for Payer: WEA Trust Commercial |
$1,162.15
|
| Rate for Payer: WPS Commercial |
$1,565.10
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
OP
|
$2,198.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2586951
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,978.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.28
|
| 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 |
$1,164.94
|
| 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 |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,022.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$1,956.22
|
| Rate for Payer: HFN Commercial |
$2,022.16
|
| 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 |
$1,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.02
|
| Rate for Payer: Quartz Commercial |
$1,428.70
|
| 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 |
$1,208.90
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,628.06
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
IP
|
$2,113.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2580818
|
| Min. Negotiated Rate |
$1,035.37 |
| Max. Negotiated Rate |
$1,943.96 |
| Rate for Payer: Aetna Commercial |
$1,901.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.89
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$1,943.96
|
| Rate for Payer: Health EOS Commercial |
$1,880.57
|
| Rate for Payer: HFN Commercial |
$1,943.96
|
| Rate for Payer: Multiplan Commercial |
$1,690.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.37
|
| Rate for Payer: Quartz Commercial |
$1,267.80
|
| Rate for Payer: WEA Trust Commercial |
$1,162.15
|
| Rate for Payer: WPS Commercial |
$1,565.10
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
OP
|
$2,304.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580815
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$2,119.68 |
| Rate for Payer: Aetna Commercial |
$2,073.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.44
|
| Rate for Payer: Aetna Managed Medicare |
$245.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,497.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.92
|
| Rate for Payer: Anthem Medicare Advantage |
$245.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.12
|
| 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 |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$2,119.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$2,050.56
|
| Rate for Payer: HFN Commercial |
$2,119.68
|
| 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 |
$1,843.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,119.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.96
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| 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 |
$1,267.20
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,706.57
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
IP
|
$2,304.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580815
|
| Min. Negotiated Rate |
$1,128.96 |
| Max. Negotiated Rate |
$2,119.68 |
| Rate for Payer: Aetna Commercial |
$2,073.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.12
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$2,119.68
|
| Rate for Payer: Health EOS Commercial |
$2,050.56
|
| Rate for Payer: HFN Commercial |
$2,119.68
|
| Rate for Payer: Multiplan Commercial |
$1,843.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,119.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.96
|
| Rate for Payer: Quartz Commercial |
$1,382.40
|
| Rate for Payer: WEA Trust Commercial |
$1,267.20
|
| Rate for Payer: WPS Commercial |
$1,706.57
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
IP
|
$2,488.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586954
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$2,288.96 |
| Rate for Payer: Aetna Commercial |
$2,239.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.64
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,288.96
|
| Rate for Payer: Health EOS Commercial |
$2,214.32
|
| Rate for Payer: HFN Commercial |
$2,288.96
|
| Rate for Payer: Multiplan Commercial |
$1,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.12
|
| Rate for Payer: Quartz Commercial |
$1,492.80
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580815
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$2,188.80 |
| Rate for Payer: Aetna Commercial |
$2,188.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.44
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$2,188.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,152.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,382.40
|
| Rate for Payer: Health EOS Commercial |
$2,096.64
|
| Rate for Payer: HFN Commercial |
$2,188.80
|
| 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 |
$1,843.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.76
|
| Rate for Payer: Quartz Commercial |
$1,313.28
|
| Rate for Payer: The Alliance Commercial |
$1,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,267.20
|
| Rate for Payer: WPS Commercial |
$1,706.57
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586954
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$2,363.60 |
| Rate for Payer: Aetna Commercial |
$2,363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.68
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,363.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,244.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,492.80
|
| Rate for Payer: Health EOS Commercial |
$2,264.08
|
| Rate for Payer: HFN Commercial |
$2,363.60
|
| 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 |
$1,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,363.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.72
|
| Rate for Payer: Quartz Commercial |
$1,418.16
|
| Rate for Payer: The Alliance Commercial |
$1,244.00
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
