|
Nucala Charge
|
Facility
|
OP
|
$4,680.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5244850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$4,305.60 |
| Rate for Payer: Aetna Commercial |
$4,212.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,024.80
|
| Rate for Payer: Aetna Managed Medicare |
$30.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,042.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,340.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,246.40
|
| Rate for Payer: Anthem Medicare Advantage |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.50
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$4,305.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.50
|
| Rate for Payer: Health EOS Commercial |
$4,165.20
|
| Rate for Payer: HFN Commercial |
$4,305.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,305.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.20
|
| Rate for Payer: Quartz Commercial |
$3,042.00
|
| Rate for Payer: Quartz Medicare Advantage |
$30.50
|
| Rate for Payer: The Alliance Commercial |
$122.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.50
|
| Rate for Payer: WEA Trust Commercial |
$2,574.00
|
| Rate for Payer: Wellcare Medicare |
$30.50
|
| Rate for Payer: WPS Commercial |
$76.20
|
|
|
Nucala Charge
|
Professional
|
Both
|
$4,680.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5244850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$4,446.00 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,024.80
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$4,446.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.48
|
| Rate for Payer: Health EOS Commercial |
$4,258.80
|
| Rate for Payer: HFN Commercial |
$4,446.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.68
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,446.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.20
|
| Rate for Payer: Quartz Commercial |
$2,667.60
|
| Rate for Payer: The Alliance Commercial |
$2,340.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.48
|
| Rate for Payer: WEA Trust Commercial |
$2,574.00
|
| Rate for Payer: WPS Commercial |
$76.20
|
|
|
Nucala Charge
|
Facility
|
IP
|
$4,680.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5244850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,293.20 |
| Max. Negotiated Rate |
$4,305.60 |
| Rate for Payer: Aetna Commercial |
$4,212.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,024.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.40
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$4,305.60
|
| Rate for Payer: Health EOS Commercial |
$4,165.20
|
| Rate for Payer: HFN Commercial |
$4,305.60
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,808.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,305.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.20
|
| Rate for Payer: Quartz Commercial |
$2,808.00
|
| Rate for Payer: WEA Trust Commercial |
$2,574.00
|
| Rate for Payer: WPS Commercial |
$3,466.48
|
|
|
Nucala Injection J2182
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5144615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$43.24 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.91
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$43.24
|
| Rate for Payer: Health EOS Commercial |
$41.83
|
| Rate for Payer: HFN Commercial |
$43.24
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: NAPHCARE Commercial |
$28.20
|
| Rate for Payer: Preferred Network Access Commercial |
$43.24
|
| Rate for Payer: Quartz Beloit One Network |
$23.03
|
| Rate for Payer: Quartz Commercial |
$28.20
|
| Rate for Payer: WEA Trust Commercial |
$25.85
|
| Rate for Payer: WPS Commercial |
$34.81
|
|
|
Nucala Injection J2182
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5144615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$122.02 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.42
|
| Rate for Payer: Aetna Managed Medicare |
$30.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.56
|
| Rate for Payer: Anthem Medicare Advantage |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.50
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$43.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.50
|
| Rate for Payer: Health EOS Commercial |
$41.83
|
| Rate for Payer: HFN Commercial |
$43.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: NAPHCARE Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$43.24
|
| Rate for Payer: Quartz Beloit One Network |
$23.03
|
| Rate for Payer: Quartz Commercial |
$30.55
|
| Rate for Payer: Quartz Medicare Advantage |
$30.50
|
| Rate for Payer: The Alliance Commercial |
$122.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.50
|
| Rate for Payer: WEA Trust Commercial |
$25.85
|
| Rate for Payer: Wellcare Medicare |
$30.50
|
| Rate for Payer: WPS Commercial |
$76.20
|
|
|
Nucala Injection J2182
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5144615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$76.20 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.42
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.48
|
| Rate for Payer: Health EOS Commercial |
$42.77
|
| Rate for Payer: HFN Commercial |
$44.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.68
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Preferred Network Access Commercial |
$44.65
|
| Rate for Payer: Quartz Beloit One Network |
$20.68
|
| Rate for Payer: Quartz Commercial |
$26.79
|
| Rate for Payer: The Alliance Commercial |
$23.50
|
| Rate for Payer: United Healthcare Medicaid |
$30.48
|
| Rate for Payer: WEA Trust Commercial |
$25.85
|
| Rate for Payer: WPS Commercial |
$76.20
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 78494
|
| Hospital Charge Code |
5375820
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,208.52 |
| Max. Negotiated Rate |
$6,024.16 |
| Rate for Payer: Aetna Commercial |
$5,893.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,631.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,470.44
|
| Rate for Payer: Cash Price |
$1,964.40
|
| Rate for Payer: Cigna Commercial |
$6,024.16
|
| Rate for Payer: Health EOS Commercial |
$5,827.72
|
| Rate for Payer: HFN Commercial |
$6,024.16
|
| Rate for Payer: Multiplan Commercial |
$5,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,928.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,024.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,208.52
|
| Rate for Payer: Quartz Commercial |
$3,928.80
|
| Rate for Payer: WEA Trust Commercial |
$3,601.40
|
| Rate for Payer: WPS Commercial |
$4,850.10
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375847
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,301.13 |
| Max. Negotiated Rate |
$6,198.04 |
| Rate for Payer: Aetna Commercial |
$6,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,570.61
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,198.04
|
| Rate for Payer: Health EOS Commercial |
$5,995.93
|
| Rate for Payer: HFN Commercial |
$6,198.04
|
| Rate for Payer: Multiplan Commercial |
$5,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,042.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.13
|
| Rate for Payer: Quartz Commercial |
$4,042.20
|
| Rate for Payer: WEA Trust Commercial |
$3,705.35
|
| Rate for Payer: WPS Commercial |
$4,990.10
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$7,362.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
5375835
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,773.04 |
| Rate for Payer: Aetna Commercial |
$6,625.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,331.32
|
| 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 |
$3,901.86
|
| 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 |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$6,773.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,119.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$6,552.18
|
| Rate for Payer: HFN Commercial |
$6,773.04
|
| 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 |
$5,889.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,773.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,607.38
|
| Rate for Payer: Quartz Commercial |
$4,785.30
|
| 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 |
$4,049.10
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$5,453.03
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$3,396.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
5375839
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,664.04 |
| Max. Negotiated Rate |
$3,124.32 |
| Rate for Payer: Aetna Commercial |
$3,056.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,124.32
|
| Rate for Payer: Health EOS Commercial |
$3,022.44
|
| Rate for Payer: HFN Commercial |
$3,124.32
|
| Rate for Payer: Multiplan Commercial |
$2,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,124.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.04
|
| Rate for Payer: Quartz Commercial |
$2,037.60
|
| Rate for Payer: WEA Trust Commercial |
$1,867.80
|
| Rate for Payer: WPS Commercial |
$2,515.42
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$3,396.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
5375839
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,056.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.56
|
| 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 |
$1,799.88
|
| 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 |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,124.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,022.44
|
| Rate for Payer: HFN Commercial |
$3,124.32
|
| 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 |
$2,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,124.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.04
|
| Rate for Payer: Quartz Commercial |
$2,207.40
|
| 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 |
$1,867.80
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$2,515.42
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
5375843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,128.07 |
| Max. Negotiated Rate |
$3,995.56 |
| Rate for Payer: Aetna Commercial |
$3,908.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,734.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,301.79
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cigna Commercial |
$3,995.56
|
| Rate for Payer: Health EOS Commercial |
$3,865.27
|
| Rate for Payer: HFN Commercial |
$3,995.56
|
| Rate for Payer: Multiplan Commercial |
$3,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,605.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,995.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,128.07
|
| Rate for Payer: Quartz Commercial |
$2,605.80
|
| Rate for Payer: WEA Trust Commercial |
$2,388.65
|
| Rate for Payer: WPS Commercial |
$3,216.86
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
5375843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,908.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,734.98
|
| 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 |
$2,301.79
|
| 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 |
$1,302.90
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cigna Commercial |
$3,995.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,430.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,865.27
|
| Rate for Payer: HFN Commercial |
$3,995.56
|
| 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 |
$3,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,995.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,128.07
|
| Rate for Payer: Quartz Commercial |
$2,822.95
|
| 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 |
$2,388.65
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$3,216.86
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375823
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,198.04 |
| Rate for Payer: Aetna Commercial |
$6,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.82
|
| 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 |
$3,570.61
|
| 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 |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,198.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,770.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$5,995.93
|
| Rate for Payer: HFN Commercial |
$6,198.04
|
| 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 |
$5,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.13
|
| Rate for Payer: Quartz Commercial |
$4,379.05
|
| 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 |
$3,705.35
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$4,990.10
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375823
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,301.13 |
| Max. Negotiated Rate |
$6,198.04 |
| Rate for Payer: Aetna Commercial |
$6,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,570.61
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,198.04
|
| Rate for Payer: Health EOS Commercial |
$5,995.93
|
| Rate for Payer: HFN Commercial |
$6,198.04
|
| Rate for Payer: Multiplan Commercial |
$5,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,042.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.13
|
| Rate for Payer: Quartz Commercial |
$4,042.20
|
| Rate for Payer: WEA Trust Commercial |
$3,705.35
|
| Rate for Payer: WPS Commercial |
$4,990.10
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,548.00
|
|
|
Service Code
|
CPT 78494
|
| Hospital Charge Code |
5375820
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$6,024.16 |
| Rate for Payer: Aetna Commercial |
$5,893.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,631.28
|
| 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 |
$3,470.44
|
| 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 |
$1,964.40
|
| Rate for Payer: Cash Price |
$1,964.40
|
| Rate for Payer: Cash Price |
$1,964.40
|
| Rate for Payer: Cigna Commercial |
$6,024.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,664.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$5,827.72
|
| Rate for Payer: HFN Commercial |
$6,024.16
|
| 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 |
$5,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$6,024.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,208.52
|
| Rate for Payer: Quartz Commercial |
$4,256.20
|
| 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 |
$3,601.40
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$4,850.10
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$3,479.00
|
|
|
Service Code
|
CPT 78469
|
| Hospital Charge Code |
5375832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,704.71 |
| Max. Negotiated Rate |
$3,200.68 |
| Rate for Payer: Aetna Commercial |
$3,131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,991.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,843.87
|
| Rate for Payer: Cash Price |
$1,043.70
|
| Rate for Payer: Cigna Commercial |
$3,200.68
|
| Rate for Payer: Health EOS Commercial |
$3,096.31
|
| Rate for Payer: HFN Commercial |
$3,200.68
|
| Rate for Payer: Multiplan Commercial |
$2,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,087.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,200.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.71
|
| Rate for Payer: Quartz Commercial |
$2,087.40
|
| Rate for Payer: WEA Trust Commercial |
$1,913.45
|
| Rate for Payer: WPS Commercial |
$2,576.90
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5375814
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$3,415.96 |
| Rate for Payer: Aetna Commercial |
$3,341.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,193.18
|
| 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 |
$1,967.89
|
| 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 |
$1,113.90
|
| Rate for Payer: Cash Price |
$1,113.90
|
| Rate for Payer: Cash Price |
$1,113.90
|
| Rate for Payer: Cigna Commercial |
$3,415.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,077.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$3,304.57
|
| Rate for Payer: HFN Commercial |
$3,415.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$2,970.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$3,415.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,819.37
|
| Rate for Payer: Quartz Commercial |
$2,413.45
|
| 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 |
$2,042.15
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$2,750.22
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375828
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,198.04 |
| Rate for Payer: Aetna Commercial |
$6,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.82
|
| 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 |
$3,570.61
|
| 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 |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,198.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,770.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$5,995.93
|
| Rate for Payer: HFN Commercial |
$6,198.04
|
| 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 |
$5,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.13
|
| Rate for Payer: Quartz Commercial |
$4,379.05
|
| 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 |
$3,705.35
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$4,990.10
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$3,713.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5375814
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,819.37 |
| Max. Negotiated Rate |
$3,415.96 |
| Rate for Payer: Aetna Commercial |
$3,341.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,193.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,967.89
|
| Rate for Payer: Cash Price |
$1,113.90
|
| Rate for Payer: Cigna Commercial |
$3,415.96
|
| Rate for Payer: Health EOS Commercial |
$3,304.57
|
| Rate for Payer: HFN Commercial |
$3,415.96
|
| Rate for Payer: Multiplan Commercial |
$2,970.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,227.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,415.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,819.37
|
| Rate for Payer: Quartz Commercial |
$2,227.80
|
| Rate for Payer: WEA Trust Commercial |
$2,042.15
|
| Rate for Payer: WPS Commercial |
$2,750.22
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375847
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,198.04 |
| Rate for Payer: Aetna Commercial |
$6,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.82
|
| 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 |
$3,570.61
|
| 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 |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,198.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,770.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$5,995.93
|
| Rate for Payer: HFN Commercial |
$6,198.04
|
| 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 |
$5,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.13
|
| Rate for Payer: Quartz Commercial |
$4,379.05
|
| 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 |
$3,705.35
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$4,990.10
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$7,362.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
5375835
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,607.38 |
| Max. Negotiated Rate |
$6,773.04 |
| Rate for Payer: Aetna Commercial |
$6,625.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,331.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,901.86
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$6,773.04
|
| Rate for Payer: Health EOS Commercial |
$6,552.18
|
| Rate for Payer: HFN Commercial |
$6,773.04
|
| Rate for Payer: Multiplan Commercial |
$5,889.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,417.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,773.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,607.38
|
| Rate for Payer: Quartz Commercial |
$4,417.20
|
| Rate for Payer: WEA Trust Commercial |
$4,049.10
|
| Rate for Payer: WPS Commercial |
$5,453.03
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$3,479.00
|
|
|
Service Code
|
CPT 78469
|
| Hospital Charge Code |
5375832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$3,200.68 |
| Rate for Payer: Aetna Commercial |
$3,131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,991.94
|
| 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 |
$1,843.87
|
| 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 |
$1,043.70
|
| Rate for Payer: Cash Price |
$1,043.70
|
| Rate for Payer: Cash Price |
$1,043.70
|
| Rate for Payer: Cigna Commercial |
$3,200.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$534.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,946.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$534.24
|
| Rate for Payer: Health EOS Commercial |
$3,096.31
|
| Rate for Payer: HFN Commercial |
$3,200.68
|
| 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 |
$2,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$801.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,200.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.71
|
| Rate for Payer: Quartz Commercial |
$2,261.35
|
| 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 |
$1,913.45
|
| Rate for Payer: Wellcare Medicare |
$534.24
|
| Rate for Payer: WPS Commercial |
$2,576.90
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375828
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,301.13 |
| Max. Negotiated Rate |
$6,198.04 |
| Rate for Payer: Aetna Commercial |
$6,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,793.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,570.61
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,198.04
|
| Rate for Payer: Health EOS Commercial |
$5,995.93
|
| Rate for Payer: HFN Commercial |
$6,198.04
|
| Rate for Payer: Multiplan Commercial |
$5,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,042.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.13
|
| Rate for Payer: Quartz Commercial |
$4,042.20
|
| Rate for Payer: WEA Trust Commercial |
$3,705.35
|
| Rate for Payer: WPS Commercial |
$4,990.10
|
|
|
Nuclear Interpretation
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 78452 26
|
| Hospital Charge Code |
5375849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$603.19 |
| Max. Negotiated Rate |
$1,132.52 |
| Rate for Payer: Aetna Commercial |
$1,107.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,058.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$652.43
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,132.52
|
| Rate for Payer: Health EOS Commercial |
$1,095.59
|
| Rate for Payer: HFN Commercial |
$1,132.52
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: NAPHCARE Commercial |
$738.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,132.52
|
| Rate for Payer: Quartz Beloit One Network |
$603.19
|
| Rate for Payer: Quartz Commercial |
$738.60
|
| Rate for Payer: WEA Trust Commercial |
$677.05
|
| Rate for Payer: WPS Commercial |
$911.80
|
|
