|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
OP
|
$2,488.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586954
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.90 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,239.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.68
|
| 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 |
$1,318.64
|
| 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 |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,288.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,392.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.90
|
| Rate for Payer: Health EOS Commercial |
$2,214.32
|
| Rate for Payer: HFN Commercial |
$2,288.96
|
| 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 |
$1,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$368.85
|
| 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 |
$1,617.20
|
| 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: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: Wellcare Medicare |
$245.90
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
|
NM Shunt Evaluation
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
631547
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,136.96 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| 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 |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| 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 |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| 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 |
$1,015.30
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
NM Shunt Evaluation
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
631547
|
| Min. Negotiated Rate |
$812.24 |
| Max. Negotiated Rate |
$1,753.70 |
| Rate for Payer: Aetna Commercial |
$1,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,753.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,107.60
|
| Rate for Payer: Health EOS Commercial |
$1,679.86
|
| Rate for Payer: HFN Commercial |
$1,753.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,103.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,103.09
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,753.70
|
| Rate for Payer: Quartz Beloit One Network |
$812.24
|
| Rate for Payer: Quartz Commercial |
$1,052.22
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
NM Shunt Evaluation
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
2586963
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$844.80 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,824.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,824.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$960.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.00
|
| Rate for Payer: Health EOS Commercial |
$1,747.20
|
| Rate for Payer: HFN Commercial |
$1,824.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,103.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,103.09
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.00
|
| Rate for Payer: Quartz Beloit One Network |
$844.80
|
| Rate for Payer: Quartz Commercial |
$1,094.40
|
| Rate for Payer: The Alliance Commercial |
$960.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
NM Shunt Evaluation
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
2586963
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$940.80 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
NM Shunt Evaluation
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
2586963
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| 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 |
$1,017.60
|
| 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 |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| 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 |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| 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 |
$1,056.00
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
NM Shunt Evaluation
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
631547
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
NM SPECT/CT Multiple
|
Professional
|
Both
|
$12,401.00
|
|
|
Service Code
|
CPT 78832 TC
|
| Hospital Charge Code |
5577506
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,812.67 |
| Max. Negotiated Rate |
$11,780.95 |
| Rate for Payer: Aetna Commercial |
$11,780.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,664.86
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cigna Commercial |
$11,780.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,200.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,440.60
|
| Rate for Payer: Health EOS Commercial |
$11,284.91
|
| Rate for Payer: HFN Commercial |
$11,780.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,812.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,812.67
|
| Rate for Payer: Multiplan Commercial |
$9,920.80
|
| Rate for Payer: Preferred Network Access Commercial |
$11,780.95
|
| Rate for Payer: Quartz Beloit One Network |
$5,456.44
|
| Rate for Payer: Quartz Commercial |
$7,068.57
|
| Rate for Payer: The Alliance Commercial |
$6,200.50
|
| Rate for Payer: WEA Trust Commercial |
$6,820.55
|
| Rate for Payer: WPS Commercial |
$9,185.42
|
|
|
NM SPECT/CT Multiple
|
Facility
|
IP
|
$12,401.00
|
|
|
Service Code
|
CPT 78832 TC
|
| Hospital Charge Code |
5577506
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6,076.49 |
| Max. Negotiated Rate |
$11,408.92 |
| Rate for Payer: Aetna Commercial |
$11,160.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,664.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,572.53
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cigna Commercial |
$11,408.92
|
| Rate for Payer: Health EOS Commercial |
$11,036.89
|
| Rate for Payer: HFN Commercial |
$11,408.92
|
| Rate for Payer: Multiplan Commercial |
$9,920.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,440.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,408.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,076.49
|
| Rate for Payer: Quartz Commercial |
$7,440.60
|
| Rate for Payer: WEA Trust Commercial |
$6,820.55
|
| Rate for Payer: WPS Commercial |
$9,185.42
|
|
|
NM SPECT/CT Multiple
|
Facility
|
OP
|
$12,401.00
|
|
|
Service Code
|
CPT 78832 TC
|
| Hospital Charge Code |
5577506
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,546.32 |
| Max. Negotiated Rate |
$11,408.92 |
| Rate for Payer: Aetna Commercial |
$11,160.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,664.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,546.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,798.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,638.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,407.01
|
| Rate for Payer: Anthem Medicare Advantage |
$1,546.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,572.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,546.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,546.32
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cigna Commercial |
$11,408.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,546.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,939.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,546.32
|
| Rate for Payer: Health EOS Commercial |
$11,036.89
|
| Rate for Payer: HFN Commercial |
$11,408.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,752.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,546.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,546.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,546.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,546.32
|
| Rate for Payer: Multiplan Commercial |
$9,920.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,319.48
|
| Rate for Payer: Preferred Network Access Commercial |
$11,408.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,076.49
|
| Rate for Payer: Quartz Commercial |
$8,060.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.32
|
| Rate for Payer: The Alliance Commercial |
$6,185.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,546.32
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$6,820.55
|
| Rate for Payer: Wellcare Medicare |
$1,546.32
|
| Rate for Payer: WPS Commercial |
$9,185.42
|
|
|
NM SPECT/CT Single
|
Facility
|
OP
|
$10,997.00
|
|
|
Service Code
|
CPT 78830 TC
|
| Hospital Charge Code |
5577509
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$10,117.24 |
| Rate for Payer: Aetna Commercial |
$9,897.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,457.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,828.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,117.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,153.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$9,787.33
|
| Rate for Payer: HFN Commercial |
$10,117.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$8,797.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$10,117.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,388.53
|
| Rate for Payer: Quartz Commercial |
$7,148.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$6,048.35
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$8,145.48
|
|
|
NM SPECT/CT Single
|
Facility
|
IP
|
$10,997.00
|
|
|
Service Code
|
CPT 78830 TC
|
| Hospital Charge Code |
5577509
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,388.53 |
| Max. Negotiated Rate |
$10,117.24 |
| Rate for Payer: Aetna Commercial |
$9,897.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,457.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,828.41
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,117.24
|
| Rate for Payer: Health EOS Commercial |
$9,787.33
|
| Rate for Payer: HFN Commercial |
$10,117.24
|
| Rate for Payer: Multiplan Commercial |
$8,797.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,598.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,117.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,388.53
|
| Rate for Payer: Quartz Commercial |
$6,598.20
|
| Rate for Payer: WEA Trust Commercial |
$6,048.35
|
| Rate for Payer: WPS Commercial |
$8,145.48
|
|
|
NM SPECT/CT Single
|
Professional
|
Both
|
$10,997.00
|
|
|
Service Code
|
CPT 78830 TC
|
| Hospital Charge Code |
5577509
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,440.56 |
| Max. Negotiated Rate |
$10,447.15 |
| Rate for Payer: Aetna Commercial |
$10,447.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,457.42
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,447.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,498.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,598.20
|
| Rate for Payer: Health EOS Commercial |
$10,007.27
|
| Rate for Payer: HFN Commercial |
$10,447.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,440.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,440.56
|
| Rate for Payer: Multiplan Commercial |
$8,797.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,447.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.68
|
| Rate for Payer: Quartz Commercial |
$6,268.29
|
| Rate for Payer: The Alliance Commercial |
$5,498.50
|
| Rate for Payer: WEA Trust Commercial |
$6,048.35
|
| Rate for Payer: WPS Commercial |
$8,145.48
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,065.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
2586967
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,858.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,775.90
|
| 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 |
$1,094.45
|
| 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 |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,899.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,155.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,837.85
|
| Rate for Payer: HFN Commercial |
$1,899.80
|
| 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 |
$1,652.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,899.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,011.85
|
| Rate for Payer: Quartz Commercial |
$1,342.25
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,135.75
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,529.55
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,065.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
2586967
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,011.85 |
| Max. Negotiated Rate |
$1,899.80 |
| Rate for Payer: Aetna Commercial |
$1,858.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,775.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.45
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,899.80
|
| Rate for Payer: Health EOS Commercial |
$1,837.85
|
| Rate for Payer: HFN Commercial |
$1,899.80
|
| Rate for Payer: Multiplan Commercial |
$1,652.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,239.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,899.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,011.85
|
| Rate for Payer: Quartz Commercial |
$1,239.00
|
| Rate for Payer: WEA Trust Commercial |
$1,135.75
|
| Rate for Payer: WPS Commercial |
$1,529.55
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Professional
|
Both
|
$1,914.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
631527
|
| Min. Negotiated Rate |
$721.57 |
| Max. Negotiated Rate |
$1,818.30 |
| Rate for Payer: Aetna Commercial |
$1,818.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,646.04
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$1,818.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$957.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,148.40
|
| Rate for Payer: Health EOS Commercial |
$1,741.74
|
| Rate for Payer: HFN Commercial |
$1,818.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$721.57
|
| Rate for Payer: Multiplan Commercial |
$1,531.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.30
|
| Rate for Payer: Quartz Beloit One Network |
$842.16
|
| Rate for Payer: Quartz Commercial |
$1,090.98
|
| Rate for Payer: The Alliance Commercial |
$957.00
|
| Rate for Payer: WEA Trust Commercial |
$1,052.70
|
| Rate for Payer: WPS Commercial |
$1,417.70
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
631527
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,760.88 |
| Rate for Payer: Aetna Commercial |
$1,722.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,646.04
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,244.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$957.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$918.72
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,014.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$1,760.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,071.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,703.46
|
| Rate for Payer: HFN Commercial |
$1,760.88
|
| 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 |
$1,531.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.88
|
| Rate for Payer: Quartz Beloit One Network |
$937.86
|
| Rate for Payer: Quartz Commercial |
$1,244.10
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,052.70
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,417.70
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
631527
|
| Min. Negotiated Rate |
$937.86 |
| Max. Negotiated Rate |
$1,760.88 |
| Rate for Payer: Aetna Commercial |
$1,722.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,646.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,014.42
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$1,760.88
|
| Rate for Payer: Health EOS Commercial |
$1,703.46
|
| Rate for Payer: HFN Commercial |
$1,760.88
|
| Rate for Payer: Multiplan Commercial |
$1,531.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,148.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.88
|
| Rate for Payer: Quartz Beloit One Network |
$937.86
|
| Rate for Payer: Quartz Commercial |
$1,148.40
|
| Rate for Payer: WEA Trust Commercial |
$1,052.70
|
| Rate for Payer: WPS Commercial |
$1,417.70
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,065.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
2586967
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$721.57 |
| Max. Negotiated Rate |
$1,961.75 |
| Rate for Payer: Aetna Commercial |
$1,961.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,775.90
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,961.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,032.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,239.00
|
| Rate for Payer: Health EOS Commercial |
$1,879.15
|
| Rate for Payer: HFN Commercial |
$1,961.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$721.57
|
| Rate for Payer: Multiplan Commercial |
$1,652.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,961.75
|
| Rate for Payer: Quartz Beloit One Network |
$908.60
|
| Rate for Payer: Quartz Commercial |
$1,177.05
|
| Rate for Payer: The Alliance Commercial |
$1,032.50
|
| Rate for Payer: WEA Trust Commercial |
$1,135.75
|
| Rate for Payer: WPS Commercial |
$1,529.55
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Facility
|
OP
|
$2,593.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2586973
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,385.56 |
| Rate for Payer: Aetna Commercial |
$2,333.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,003.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,602.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.58
|
| Rate for Payer: Anthem Medicare Advantage |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,374.29
|
| 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 |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,385.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,451.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$2,307.77
|
| Rate for Payer: HFN Commercial |
$2,385.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,987.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$534.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$534.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$534.24
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.57
|
| Rate for Payer: Quartz Commercial |
$1,685.45
|
| 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: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Professional
|
Both
|
$2,593.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2586973
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,069.94 |
| Max. Negotiated Rate |
$2,463.35 |
| Rate for Payer: Aetna Commercial |
$2,463.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,463.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,296.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,555.80
|
| Rate for Payer: Health EOS Commercial |
$2,359.63
|
| Rate for Payer: HFN Commercial |
$2,463.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,069.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,069.94
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,463.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.92
|
| Rate for Payer: Quartz Commercial |
$1,478.01
|
| Rate for Payer: The Alliance Commercial |
$1,296.50
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Facility
|
IP
|
$2,593.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2586973
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,270.57 |
| Max. Negotiated Rate |
$2,385.56 |
| Rate for Payer: Aetna Commercial |
$2,333.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,374.29
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,385.56
|
| Rate for Payer: Health EOS Commercial |
$2,307.77
|
| Rate for Payer: HFN Commercial |
$2,385.56
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.57
|
| Rate for Payer: Quartz Commercial |
$1,555.80
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Facility
|
IP
|
$2,304.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
631467
|
| 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 Thyroid CA Mets Imaging Whole Body
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
631467
|
| Min. Negotiated Rate |
$1,013.76 |
| 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 |
$1,069.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,069.94
|
| 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 Thyroid CA Mets Imaging Whole Body
|
Facility
|
OP
|
$2,304.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
631467
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$2,136.96 |
| Rate for Payer: Aetna Commercial |
$2,073.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.44
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| 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 |
$534.24
|
| 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 |
$534.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$534.24
|
| 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 |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| 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 |
$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 |
$1,843.20
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| 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 |
$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 |
$1,267.20
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$1,706.57
|
|
