|
NM Thyroid Imaging Only
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2586975
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$493.92 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.24
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$604.80
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$604.80
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
NM Thyroid Imaging Only
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2586975
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$443.52 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Aetna Commercial |
$957.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$957.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$604.80
|
| Rate for Payer: Health EOS Commercial |
$917.28
|
| Rate for Payer: HFN Commercial |
$957.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$665.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$665.83
|
| Rate for Payer: Multiplan Commercial |
$806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$957.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.52
|
| Rate for Payer: Quartz Commercial |
$574.56
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: WEA Trust Commercial |
$554.40
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
NM Thyroid Imaging Only
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2586975
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$907.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.88
|
| 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 |
$534.24
|
| 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 |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$927.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$564.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$897.12
|
| Rate for Payer: HFN Commercial |
$927.36
|
| 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 |
$806.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$927.36
|
| Rate for Payer: Quartz Beloit One Network |
$493.92
|
| Rate for Payer: Quartz Commercial |
$655.20
|
| 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 |
$554.40
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$746.63
|
|
|
NM Thyroid Imaging Only
|
Professional
|
Both
|
$969.00
|
|
| Hospital Charge Code |
631461
|
| Min. Negotiated Rate |
$426.36 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Aetna Commercial |
$920.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.34
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$484.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.40
|
| Rate for Payer: Health EOS Commercial |
$881.79
|
| Rate for Payer: HFN Commercial |
$920.55
|
| Rate for Payer: Multiplan Commercial |
$775.20
|
| Rate for Payer: Preferred Network Access Commercial |
$920.55
|
| Rate for Payer: Quartz Beloit One Network |
$426.36
|
| Rate for Payer: Quartz Commercial |
$552.33
|
| Rate for Payer: The Alliance Commercial |
$484.50
|
| Rate for Payer: WEA Trust Commercial |
$532.95
|
| Rate for Payer: WPS Commercial |
$717.74
|
|
|
NM Thyroid Imaging Only
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
631461
|
| Min. Negotiated Rate |
$474.81 |
| Max. Negotiated Rate |
$891.48 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.57
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$891.48
|
| Rate for Payer: Health EOS Commercial |
$862.41
|
| Rate for Payer: HFN Commercial |
$891.48
|
| Rate for Payer: Multiplan Commercial |
$775.20
|
| Rate for Payer: NAPHCARE Commercial |
$581.40
|
| Rate for Payer: Preferred Network Access Commercial |
$891.48
|
| Rate for Payer: Quartz Beloit One Network |
$474.81
|
| Rate for Payer: Quartz Commercial |
$581.40
|
| Rate for Payer: WEA Trust Commercial |
$532.95
|
| Rate for Payer: WPS Commercial |
$717.74
|
|
|
NM Thyroid Imaging Only
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
631461
|
| Min. Negotiated Rate |
$271.32 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.34
|
| Rate for Payer: Aetna Managed Medicare |
$271.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$629.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$484.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$465.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.57
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$891.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$542.25
|
| Rate for Payer: Health EOS Commercial |
$862.41
|
| Rate for Payer: HFN Commercial |
$891.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.75
|
| Rate for Payer: Multiplan Commercial |
$775.20
|
| Rate for Payer: NAPHCARE Commercial |
$581.40
|
| Rate for Payer: Preferred Network Access Commercial |
$891.48
|
| Rate for Payer: Quartz Beloit One Network |
$474.81
|
| Rate for Payer: Quartz Commercial |
$629.85
|
| Rate for Payer: Quartz Medicare Advantage |
$581.40
|
| Rate for Payer: The Alliance Commercial |
$3,876.00
|
| Rate for Payer: WEA Trust Commercial |
$532.95
|
| Rate for Payer: WPS Commercial |
$717.74
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2586977
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.93 |
| Max. Negotiated Rate |
$1,892.44 |
| Rate for Payer: Aetna Commercial |
$1,851.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,769.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,090.21
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna Commercial |
$1,892.44
|
| Rate for Payer: Health EOS Commercial |
$1,830.73
|
| Rate for Payer: HFN Commercial |
$1,892.44
|
| Rate for Payer: Multiplan Commercial |
$1,645.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,234.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,892.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.93
|
| Rate for Payer: Quartz Commercial |
$1,234.20
|
| Rate for Payer: WEA Trust Commercial |
$1,131.35
|
| Rate for Payer: WPS Commercial |
$1,523.62
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2586977
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,851.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,769.02
|
| 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 |
$1,090.21
|
| 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 |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna Commercial |
$1,892.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,151.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,830.73
|
| Rate for Payer: HFN Commercial |
$1,892.44
|
| 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 |
$1,645.60
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,892.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.93
|
| Rate for Payer: Quartz Commercial |
$1,337.05
|
| 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: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,131.35
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,523.62
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
IP
|
$1,613.00
|
|
| Hospital Charge Code |
631453
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
OP
|
$1,613.00
|
|
| Hospital Charge Code |
631453
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2586977
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$814.48 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: Aetna Commercial |
$1,954.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,769.02
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna Commercial |
$1,954.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,028.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.20
|
| Rate for Payer: Health EOS Commercial |
$1,871.87
|
| Rate for Payer: HFN Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$814.48
|
| Rate for Payer: Multiplan Commercial |
$1,645.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,954.15
|
| Rate for Payer: Quartz Beloit One Network |
$905.08
|
| Rate for Payer: Quartz Commercial |
$1,172.49
|
| Rate for Payer: The Alliance Commercial |
$1,028.50
|
| Rate for Payer: WEA Trust Commercial |
$1,131.35
|
| Rate for Payer: WPS Commercial |
$1,523.62
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Professional
|
Both
|
$1,613.00
|
|
| Hospital Charge Code |
631453
|
| Min. Negotiated Rate |
$709.72 |
| Max. Negotiated Rate |
$1,532.35 |
| Rate for Payer: Aetna Commercial |
$1,532.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,532.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$806.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$967.80
|
| Rate for Payer: Health EOS Commercial |
$1,467.83
|
| Rate for Payer: HFN Commercial |
$1,532.35
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.35
|
| Rate for Payer: Quartz Beloit One Network |
$709.72
|
| Rate for Payer: Quartz Commercial |
$919.41
|
| Rate for Payer: The Alliance Commercial |
$806.50
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Professional
|
Both
|
$857.00
|
|
| Hospital Charge Code |
631435
|
| Min. Negotiated Rate |
$377.08 |
| Max. Negotiated Rate |
$814.15 |
| 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: 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: 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 Thyroid Uptake Multiple Determinate
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
631435
|
| Min. Negotiated Rate |
$239.96 |
| Max. Negotiated Rate |
$3,428.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Aetna Managed Medicare |
$239.96
|
| 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: 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: Dean Health DHI/DHP/ASO |
$479.58
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.75
|
| 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 |
$557.05
|
| Rate for Payer: Quartz Medicare Advantage |
$514.20
|
| Rate for Payer: The Alliance Commercial |
$3,428.00
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2586983
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$819.72 |
| Rate for Payer: Aetna Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.23
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$819.72
|
| Rate for Payer: Health EOS Commercial |
$792.99
|
| Rate for Payer: HFN Commercial |
$819.72
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: NAPHCARE Commercial |
$534.60
|
| Rate for Payer: Preferred Network Access Commercial |
$819.72
|
| Rate for Payer: Quartz Beloit One Network |
$436.59
|
| Rate for Payer: Quartz Commercial |
$534.60
|
| Rate for Payer: WEA Trust Commercial |
$490.05
|
| Rate for Payer: WPS Commercial |
$659.96
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2586983
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| 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 |
$472.23
|
| 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 |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$819.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$792.99
|
| Rate for Payer: HFN Commercial |
$819.72
|
| 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 |
$712.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$819.72
|
| Rate for Payer: Quartz Beloit One Network |
$436.59
|
| Rate for Payer: Quartz Commercial |
$579.15
|
| 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 |
$490.05
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$659.96
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2586983
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$275.83 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Aetna Commercial |
$846.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$846.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$445.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.60
|
| Rate for Payer: Health EOS Commercial |
$810.81
|
| Rate for Payer: HFN Commercial |
$846.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$275.83
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$846.45
|
| Rate for Payer: Quartz Beloit One Network |
$392.04
|
| Rate for Payer: Quartz Commercial |
$507.87
|
| Rate for Payer: The Alliance Commercial |
$445.50
|
| Rate for Payer: WEA Trust Commercial |
$490.05
|
| Rate for Payer: WPS Commercial |
$659.96
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
631435
|
| 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 Tumor Limited Scan - Oncoscint
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675705
|
| Min. Negotiated Rate |
$1,080.45 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Aetna Commercial |
$1,984.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,896.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,168.65
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,028.60
|
| Rate for Payer: Health EOS Commercial |
$1,962.45
|
| Rate for Payer: HFN Commercial |
$2,028.60
|
| Rate for Payer: Multiplan Commercial |
$1,764.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,028.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.45
|
| Rate for Payer: Quartz Commercial |
$1,323.00
|
| Rate for Payer: WEA Trust Commercial |
$1,212.75
|
| Rate for Payer: WPS Commercial |
$1,633.24
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675705
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,028.60 |
| Rate for Payer: Aetna Commercial |
$1,984.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,896.30
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.40
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,168.65
|
| 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 |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,028.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,233.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,962.45
|
| Rate for Payer: HFN Commercial |
$2,028.60
|
| 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 |
$1,764.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,028.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.45
|
| Rate for Payer: Quartz Commercial |
$1,433.25
|
| 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: WEA Trust Commercial |
$1,212.75
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,633.24
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675705
|
| Min. Negotiated Rate |
$871.10 |
| Max. Negotiated Rate |
$2,094.75 |
| Rate for Payer: Aetna Commercial |
$2,094.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,896.30
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,094.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,102.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,323.00
|
| Rate for Payer: Health EOS Commercial |
$2,006.55
|
| Rate for Payer: HFN Commercial |
$2,094.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.10
|
| Rate for Payer: Multiplan Commercial |
$1,764.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,094.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.20
|
| Rate for Payer: Quartz Commercial |
$1,256.85
|
| Rate for Payer: The Alliance Commercial |
$1,102.50
|
| Rate for Payer: WEA Trust Commercial |
$1,212.75
|
| Rate for Payer: WPS Commercial |
$1,633.24
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586989
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| 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 |
$1,215.29
|
| 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 |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| 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 |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,490.45
|
| 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 |
$1,261.15
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586989
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,123.57 |
| Max. Negotiated Rate |
$2,109.56 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,375.80
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586989
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$871.10 |
| Max. Negotiated Rate |
$2,178.35 |
| Rate for Payer: Aetna Commercial |
$2,178.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,178.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,375.80
|
| Rate for Payer: Health EOS Commercial |
$2,086.63
|
| Rate for Payer: HFN Commercial |
$2,178.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.10
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.92
|
| Rate for Payer: Quartz Commercial |
$1,307.01
|
| Rate for Payer: The Alliance Commercial |
$1,146.50
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
NM Tumor Localization/Limited
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586993
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| 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 |
$1,215.29
|
| 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 |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| 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 |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,490.45
|
| 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 |
$1,261.15
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
