|
NM Tumor Localization/Limited
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586993
|
|
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
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586993
|
|
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 Localization/Limited
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
631415
|
| 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 Localization/Limited
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
631415
|
| 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 Localization/Limited
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
631415
|
| 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 Localization/Multiple Areas
|
Facility
|
OP
|
$3,899.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$3,587.08 |
| Rate for Payer: Aetna Commercial |
$3,509.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,353.14
|
| 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 |
$2,066.47
|
| 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 |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cigna Commercial |
$3,587.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,181.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$3,470.11
|
| Rate for Payer: HFN Commercial |
$3,587.08
|
| 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 |
$3,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$3,587.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,910.51
|
| Rate for Payer: Quartz Commercial |
$2,534.35
|
| 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 |
$2,144.45
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,887.99
|
|
|
NM Tumor Localization/Multiple Areas
|
Facility
|
IP
|
$3,899.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,910.51 |
| Max. Negotiated Rate |
$3,587.08 |
| Rate for Payer: Aetna Commercial |
$3,509.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,353.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,066.47
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cigna Commercial |
$3,587.08
|
| Rate for Payer: Health EOS Commercial |
$3,470.11
|
| Rate for Payer: HFN Commercial |
$3,587.08
|
| Rate for Payer: Multiplan Commercial |
$3,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,339.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,587.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,910.51
|
| Rate for Payer: Quartz Commercial |
$2,339.40
|
| Rate for Payer: WEA Trust Commercial |
$2,144.45
|
| Rate for Payer: WPS Commercial |
$2,887.99
|
|
|
NM Tumor Localization/Multiple Areas
|
Professional
|
Both
|
$3,899.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$962.24 |
| Max. Negotiated Rate |
$3,704.05 |
| Rate for Payer: Aetna Commercial |
$3,704.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,353.14
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cigna Commercial |
$3,704.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,949.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,339.40
|
| Rate for Payer: Health EOS Commercial |
$3,548.09
|
| Rate for Payer: HFN Commercial |
$3,704.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$962.24
|
| Rate for Payer: Multiplan Commercial |
$3,119.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,704.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,715.56
|
| Rate for Payer: Quartz Commercial |
$2,222.43
|
| Rate for Payer: The Alliance Commercial |
$1,949.50
|
| Rate for Payer: WEA Trust Commercial |
$2,144.45
|
| Rate for Payer: WPS Commercial |
$2,887.99
|
|
|
NM Tumor Localization Spect
|
Facility
|
OP
|
$3,379.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
631421
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,041.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,905.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,196.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,689.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,621.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,790.87
|
| 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 |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna Commercial |
$3,108.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,890.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,007.31
|
| Rate for Payer: HFN Commercial |
$3,108.68
|
| 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 |
$2,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,108.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,655.71
|
| Rate for Payer: Quartz Commercial |
$2,196.35
|
| 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: WEA Trust Commercial |
$1,858.45
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,502.83
|
|
|
NM Tumor Localization Spect
|
Facility
|
IP
|
$3,379.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
631421
|
| Min. Negotiated Rate |
$1,655.71 |
| Max. Negotiated Rate |
$3,108.68 |
| Rate for Payer: Aetna Commercial |
$3,041.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,905.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,790.87
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna Commercial |
$3,108.68
|
| Rate for Payer: Health EOS Commercial |
$3,007.31
|
| Rate for Payer: HFN Commercial |
$3,108.68
|
| Rate for Payer: Multiplan Commercial |
$2,703.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,027.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,108.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,655.71
|
| Rate for Payer: Quartz Commercial |
$2,027.40
|
| Rate for Payer: WEA Trust Commercial |
$1,858.45
|
| Rate for Payer: WPS Commercial |
$2,502.83
|
|
|
NM Tumor Localization Spect
|
Professional
|
Both
|
$3,379.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
631421
|
| Min. Negotiated Rate |
$1,321.03 |
| Max. Negotiated Rate |
$3,210.05 |
| Rate for Payer: Aetna Commercial |
$3,210.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,905.94
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna Commercial |
$3,210.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,689.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,027.40
|
| Rate for Payer: Health EOS Commercial |
$3,074.89
|
| Rate for Payer: HFN Commercial |
$3,210.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,321.03
|
| Rate for Payer: Multiplan Commercial |
$2,703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,210.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,486.76
|
| Rate for Payer: Quartz Commercial |
$1,926.03
|
| Rate for Payer: The Alliance Commercial |
$1,689.50
|
| Rate for Payer: WEA Trust Commercial |
$1,858.45
|
| Rate for Payer: WPS Commercial |
$2,502.83
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586999
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,609.96 |
| Max. Negotiated Rate |
$3,476.05 |
| Rate for Payer: Aetna Commercial |
$3,476.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,476.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,829.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.40
|
| Rate for Payer: Health EOS Commercial |
$3,329.69
|
| Rate for Payer: HFN Commercial |
$3,476.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,250.16
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,476.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,609.96
|
| Rate for Payer: Quartz Commercial |
$2,085.63
|
| Rate for Payer: The Alliance Commercial |
$1,829.50
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586999
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,792.91 |
| Max. Negotiated Rate |
$3,366.28 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.27
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,195.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,195.40
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586999
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| 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 |
$1,939.27
|
| 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 |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,047.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| 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 |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,378.35
|
| 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 |
$2,012.45
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
661631
|
| Min. Negotiated Rate |
$1,723.82 |
| Max. Negotiated Rate |
$3,236.56 |
| Rate for Payer: Aetna Commercial |
$3,166.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.54
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,236.56
|
| Rate for Payer: Health EOS Commercial |
$3,131.02
|
| Rate for Payer: HFN Commercial |
$3,236.56
|
| Rate for Payer: Multiplan Commercial |
$2,814.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,110.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,236.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.82
|
| Rate for Payer: Quartz Commercial |
$2,110.80
|
| Rate for Payer: WEA Trust Commercial |
$1,934.90
|
| Rate for Payer: WPS Commercial |
$2,605.78
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
661631
|
| Min. Negotiated Rate |
$1,547.92 |
| Max. Negotiated Rate |
$3,342.10 |
| Rate for Payer: Aetna Commercial |
$3,342.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.48
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,342.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,759.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,110.80
|
| Rate for Payer: Health EOS Commercial |
$3,201.38
|
| Rate for Payer: HFN Commercial |
$3,342.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,250.16
|
| Rate for Payer: Multiplan Commercial |
$2,814.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,342.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.92
|
| Rate for Payer: Quartz Commercial |
$2,005.26
|
| Rate for Payer: The Alliance Commercial |
$1,759.00
|
| Rate for Payer: WEA Trust Commercial |
$1,934.90
|
| Rate for Payer: WPS Commercial |
$2,605.78
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
OP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
661631
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,166.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,286.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,759.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,688.64
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.54
|
| 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 |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,236.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,968.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,131.02
|
| Rate for Payer: HFN Commercial |
$3,236.56
|
| 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 |
$2,814.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,236.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.82
|
| Rate for Payer: Quartz Commercial |
$2,286.70
|
| 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: WEA Trust Commercial |
$1,934.90
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,605.78
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
675711
|
| Min. Negotiated Rate |
$1,723.82 |
| Max. Negotiated Rate |
$3,236.56 |
| Rate for Payer: Aetna Commercial |
$3,166.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.54
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,236.56
|
| Rate for Payer: Health EOS Commercial |
$3,131.02
|
| Rate for Payer: HFN Commercial |
$3,236.56
|
| Rate for Payer: Multiplan Commercial |
$2,814.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,110.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,236.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.82
|
| Rate for Payer: Quartz Commercial |
$2,110.80
|
| Rate for Payer: WEA Trust Commercial |
$1,934.90
|
| Rate for Payer: WPS Commercial |
$2,605.78
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
OP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
675711
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,166.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,286.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,759.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,688.64
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,864.54
|
| 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 |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,236.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,968.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,131.02
|
| Rate for Payer: HFN Commercial |
$3,236.56
|
| 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 |
$2,814.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,236.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.82
|
| Rate for Payer: Quartz Commercial |
$2,286.70
|
| 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: WEA Trust Commercial |
$1,934.90
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,605.78
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,609.96 |
| Max. Negotiated Rate |
$3,476.05 |
| Rate for Payer: Aetna Commercial |
$3,476.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,476.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,829.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.40
|
| Rate for Payer: Health EOS Commercial |
$3,329.69
|
| Rate for Payer: HFN Commercial |
$3,476.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,250.16
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,476.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,609.96
|
| Rate for Payer: Quartz Commercial |
$2,085.63
|
| Rate for Payer: The Alliance Commercial |
$1,829.50
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
675711
|
| Min. Negotiated Rate |
$1,547.92 |
| Max. Negotiated Rate |
$3,342.10 |
| Rate for Payer: Aetna Commercial |
$3,342.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.48
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,342.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,759.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,110.80
|
| Rate for Payer: Health EOS Commercial |
$3,201.38
|
| Rate for Payer: HFN Commercial |
$3,342.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,250.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,250.16
|
| Rate for Payer: Multiplan Commercial |
$2,814.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,342.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.92
|
| Rate for Payer: Quartz Commercial |
$2,005.26
|
| Rate for Payer: The Alliance Commercial |
$1,759.00
|
| Rate for Payer: WEA Trust Commercial |
$1,934.90
|
| Rate for Payer: WPS Commercial |
$2,605.78
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| 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 |
$1,939.27
|
| 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 |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,047.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| 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 |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,378.35
|
| 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 |
$2,012.45
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,792.91 |
| Max. Negotiated Rate |
$3,366.28 |
| Rate for Payer: Aetna Commercial |
$3,293.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.27
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,366.28
|
| Rate for Payer: Health EOS Commercial |
$3,256.51
|
| Rate for Payer: HFN Commercial |
$3,366.28
|
| Rate for Payer: Multiplan Commercial |
$2,927.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,195.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.91
|
| Rate for Payer: Quartz Commercial |
$2,195.40
|
| Rate for Payer: WEA Trust Commercial |
$2,012.45
|
| Rate for Payer: WPS Commercial |
$2,710.22
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$702.17 |
| Max. Negotiated Rate |
$1,318.36 |
| Rate for Payer: Aetna Commercial |
$1,289.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,232.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$759.49
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,318.36
|
| Rate for Payer: Health EOS Commercial |
$1,275.37
|
| Rate for Payer: HFN Commercial |
$1,318.36
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$859.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,318.36
|
| Rate for Payer: Quartz Beloit One Network |
$702.17
|
| Rate for Payer: Quartz Commercial |
$859.80
|
| Rate for Payer: WEA Trust Commercial |
$788.15
|
| Rate for Payer: WPS Commercial |
$1,061.42
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$730.10 |
| Max. Negotiated Rate |
$1,370.80 |
| Rate for Payer: Aetna Commercial |
$1,341.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.70
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,370.80
|
| Rate for Payer: Health EOS Commercial |
$1,326.10
|
| Rate for Payer: HFN Commercial |
$1,370.80
|
| Rate for Payer: Multiplan Commercial |
$1,192.00
|
| Rate for Payer: NAPHCARE Commercial |
$894.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.80
|
| Rate for Payer: Quartz Beloit One Network |
$730.10
|
| Rate for Payer: Quartz Commercial |
$894.00
|
| Rate for Payer: WEA Trust Commercial |
$819.50
|
| Rate for Payer: WPS Commercial |
$1,103.64
|
|
